Neurol. pro Praxi, 2002; 1: 28-32

Léčba spondylogenní cervikální myelopatie – standard či problém? Pohled neurologa a neurochirurga

prof. MUDr. Zdeněk Kadaňka, CSc.1, doc. MUDr. Josef Bednařík, CSc.1, doc. MUDr. Vladimír Smrčka, CSc.2, MUDr. Miroslav Mareš1
1 I. neurologická klinika LF MU a FN u sv. Anny Brno
2 Neurochirurgická klinika LF MU a FN Brno

Keywords: spondylóza, spondylogenní myelopatie, myelopatie, nemoci míchy.

Published: December 31, 2002  Show citation

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Kadaňka Z, Bednařík J, Smrčka V, Mareš M. Léčba spondylogenní cervikální myelopatie – standard či problém? Pohled neurologa a neurochirurga. Neurol. praxi. 2002;3(1):28-32.

Léčba spondylogenní cervikální myelopatie, zejména lehkých a středních forem bez progrese, je velkým dilematem pro ty, kteří se zabývají řešením tohoto onemocnění. Přístup konzervativní i chirurgický má své výhody i nevýhody a dosud není k disposici dostatek ověřených informací, které by napomohly v rozhodování, který přístup a ve které fázi nemoci zvolit. K optimální volbě terapie potřebujeme znát přirozený průběh nemoci, výsledky operací a výsledky konzervativní léčby. Ze všech těchto oblastí máme jen zprávy nízké úrovně validity z pohledu současných názorů na kvalitu vědeckých informací. Jde většinou o data ze studií retrospektivních s nejednotným a nedostatečným designem, s nedostatečně dlouhou dobou sledování, bez jasných kritérií a statistického zpracování a nedostatečnou objektivitou pozorování. Prospektivní randomizované studie chybí. Uspořádání takové studie je ovšem u této choroby s mimořádně dlouhým a nepředvídatelným klinickým i preklinickým průběhem a nutností dlouhodobého sledování mimořádně obtížné. Z dosavadních poznatků vyplývá, že chirurgická léčba by se měla volit především u progredujících forem nemoci, u případů s těžkým klinickým obrazem, u masivních míšních kompresí s respektováním všech kontraindikací, zejména mimopáteřních. Konzervativní přístup by se měl rezervovat pro nemocné s neprogredující formou nemoci, s malou míšní kompresí a mírným klinickým obrazem, nebo tam, kde je operační výkon spojen s mimořádně velkými riziky. Nezbytným předpokladem dobrého terapeutického výsledku je přesná diagnostika zohledňující ubikvitárnost spondylózních degenerativních změn páteře a nespecifičnost klinického obrazu.

Neurologická klinika LF MU a FN Brno

Neurochirurgická klinika LF MU a FN Brno

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