Chirurgische und konservative Therapie traumatischer Rückenmarkverletzungen

Kernaussagen

• Die traumatische Rückenmarkschädigung führt zu einer inkompletten oder kompletten Para- oder Tetraparese mit einer erheblichen Einschränkung der Lebensqualität und hohen sozioökonomischen Kosten.

• Hauptrisikofaktoren für das Überleben sind das Alter, die Höhe der Rückenmarkschädigung, das Ausmaß neurologischer Defizite und pulmonale Infektionen.

• Zur Erstversorgung gehören die Sicherung der Vitalfunktionen am Unfallort (ggf. Intubation) und eine Immobilisierung (Stiff-neck, Vakuummatratze).

• Bei einer Kompression des Rückenmarks oder einer instabilen Fraktur ist eine Entlastung des Rückenmarks mit zusätzlicher Stabilisierung innerhalb von 24 Stunden erforderlich.

• Besonders respiratorische und kardiovaskuläre Komplikationen, Thrombembolien und ein gestörter Metabolismus sowie Infektionen sind eine Herausforderung in der weiteren intensivmedizinischen Behandlung.

• Besonders bei jungen Patienten mit inkompletter Querschnittslähmung kann die Rehabilitationsbehandlung funktionelle Erfolge erreichen.

• Literatur

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