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Rheumatoide Arthritis der zervikalen Wirbelsäule

Diagnostik und Therapie rheumatisch bedingter Instabilitäten

Cervical spine involvement in rheumatoid arthritis

Diagnostics and treatment of instability due to rheumatism

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Zusammenfassung

Neben dem Befall der kleinen peripheren Gelenke gilt die Halswirbelsäule als die am zweithäufigsten betroffene Körperregion einer rheumatoiden Arthritis. Zurückzuführen auf eine Verbesserung der medikamentösen Therapien in den letzten Jahren, zeigen neuere Daten eine rückläufige Prävalenz der zervikalen Beteiligungen. Eine operative Therapie spielt jedoch je nach Ausprägung der Erkrankung weiterhin eine relevante Rolle. Die Folgen eines Befalls der Halswirbelsäule sind kraniozervikale Instabilitäten, die zu starken Schmerzen bis hin zu neuralen Defiziten und Tod führen können. Eine multimodale konservative Therapie kann zu einer Linderung der Schmerzen führen, bei Manifestation therapieresistenter Schmerzen oder neuralen Defiziten ist eine Verbesserung des Outcomes ausschließlich durch eine operative Therapie zu erlangen. Bei isolierter atlantoaxialer Instabilität (AAS) ist die atlantoaxiale Fusion mittels C1–2-Fixation nach Harms und Goel Mittel der Wahl. Eine Stabilisierung unter Einschluss von C0 sollte aufgrund der erheblichen Bewegungseinschränkung, wenn möglich, vermieden werden.

Abstract

In addition to involvement of small peripheral joints, the cervical spine is the second most affected body region in rheumatoid arthritis (RA). Due to improvement of pharmaceutical treatment in recent years, new data show that there is a decreasing prevalence of cervical involvement; however, depending on the severity of cervical lesions surgical treatment still plays an important role. The sequelae of involvement of the cervical spine are craniocervical and atlantoaxial instability, which can cause severe pain, neural deficits and even death. Multimodal conservative treatment can lead to an alleviation of pain but in cases of therapy-resistant pain or neural deficits surgical treatment alone is essential to improve patient outcome. For isolated atlantoaxial instability (AAS), atlantoaxial fusion by posterior C1–2 fixation according to Harms and Goel is the method of choice. Posterior stabilization including C0 should be avoided whenever possible due to substantial limitations in range of movement.

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Abbreviations

AAI:

Atlantoaxiale Instabilität

AAS:

Atlantoaxiale Subluxation

BMI:

Body-Mass-Index

CRP:

C-reaktives Protein

CS:

Cranial Settling

CT:

Computertomographie

DMARD:

Disease modifying antirheumatic drug

HWS:

Halswirbelsäule

MRT:

Magnetresonanztomographie

PEG:

Perkutane endoskopische Gastrostomie

RA:

Rheumatoide Arthritis

SAS:

Subaxiale Dislokation

VT:

Vertikale Dislokation

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  1. Klinik für Neurochirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81679, München, Deutschland

    I. Janssen, E. Shiban & B. Meyer

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  1. I. Janssen
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  2. E. Shiban
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Correspondence to I. Janssen.

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Interessenkonflikt

I. Janssen gibt an, dass kein Interessenkonflikt besteht. E. Shiban: wissenschaftlicher Beirat: Icotec, Nevro. B. Meyer: wissenschaftlicher Beirat: Ulrich Medical, Brain Lab, Medtronic, Spineart, Relievant Medsystems.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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J. Grifka, Bad Abbach

G. Maderbacher, Bad Abbach

C. Baier, Bad Abbach

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Janssen, I., Shiban, E. & Meyer, B. Rheumatoide Arthritis der zervikalen Wirbelsäule. Z Rheumatol 77, 889–895 (2018). https://doi.org/10.1007/s00393-018-0564-9

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  • DOI: https://doi.org/10.1007/s00393-018-0564-9

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