Multidetektor-CT bei Erwachsenen mit stumpfem Trauma der Halswirbelsäule^[1]

Zusammenfassung

Die Bildgebung der Halswirbelsäule wurde seit der Einführung der 64-Zeilen-CT-Scanner im Jahr 2004 durch eine Reihe von Neuerungen weiterentwickelt. Immer umfangreicheres Evidenzmaterial spricht für den Einsatz der Multidetektor-CT als eigenständigen Screening-Test zum Ausschluss zervikaler Verletzungen bei polytraumatisierten Patienten mit Bewusstseinstrübung. Zunehmende Akzeptanz gewinnt bei den Wirbelsäulenchirurgen eine neue Grading-Skala, die auf CT- und MRT-Befunden und auf dem SLIC-Scoring-System für Verletzungen der Halswirbelsäule (Subaxial Injury Classification and Scoring System) basiert. Zurzeit werden die gebräuchlichen radiografischen Parameter für die Evaluation kraniozervikaler Distraktionsverletzungen unter Verwendung der Multidetektor-CT neu bewertet. Bislang werden die meisten Patienten mit stumpfem Trauma nicht operativ behandelt, doch haben neue Erkenntnisse bezüglich der Stabilität der Wirbelsäule sowie die Entwicklung neuer Operationstechniken und neuer Hardware dazu geführt, dass der aktuelle Trend bei den Behandlungsstrategien zunehmend in Richtung chirurgischer Interventionen geht. Für die Radiologen ist es daher unerlässlich zu bestimmen, anhand welcher Befunde sich Verletzungen, die wegen Instabilität des Bandapparats oder hoher Wahrscheinlichkeit von Nonfusion einer operativen Stabilisierung bedürfen, von jenen unterscheiden lassen, die klassischerweise stabil sind und allein mittels Halskragen oder Halo-Weste behandelt werden können. Dieser Artikel gibt einen Überblick über das Spektrum der Halswirbelsäulenverletzungen, vom kraniozervikalen Übergang bis zur subaxialen Wirbelsäule, und stellt die gebräuchlichsten Grading-Systeme für die einzelnen Verletzungsarten vor.

Abstract

A number of new developments in cervical spine imaging have transpired since the introduction of 64-section computed tomographic (CT) scanners in 2004. An increasing body of evidence favors the use of multidetector CT as a stand-alone screening test for excluding cervical injuries in polytrauma patients with obtundation. A new grading scale that is based on CT and magnetic resonance (MR) imaging findings, the cervical spine Subaxial Injury Classification and Scoring (SLIC) system, is gaining acceptance among spine surgeons. Radiographic measurements described for the evaluation of craniocervical distraction injuries are now being reevaluated with the use of multidetector CT. Although most patients with blunt trauma are now treated nonsurgically, evolution in the understanding of spinal stability, as well as the development of new surgical techniques and hardware, has driven management strategies that are increasingly favorable toward surgical intervention. It is therefore essential that radiologists recognize findings that distinguish injuries with ligamentous instability or a high likelihood of nonfusion that require surgical stabilization from those that are classically stable and can be treated with a collar or halo vest alone. The purpose of this article is to review the spectrum of cervical spine injuries, from the craniocervical junction through the subaxial spine, and present the most widely used grading systems for each injury type.

¹ © 2015 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2014; 34: 1842 – 1865. Online published in 10.1148 /rg.347130094. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

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