Standards und Leitlinien bei der Therapie degenerativer Erkrankungen der Halswirbelsäule

Degenerative diseases of the cervical spine are common in our general population and will gain further relevance in the forthcoming decades due to the increasingly aging society. The natural course is typically benign, hence numerous conservative measures should represent the primary therapy in the absence of significant deficits. Conversely, urgent decompression of neural structures should be mandated in case of progressive neurological deficits. In case of persistence of a purely painful cervical radiculopathy, established anterior and posterior procedures exist, resulting in excellent treatment success with justifiable risk. Patients retain their benefit in the long-term follow-up, especially in case of the novel disc arthroplasty procedures, for which studies have now demonstrated a benefit in terms of the rate of secondary adjacent level degeneration compared to fusion. For chronic pain syndromes, an intensive multimodal treatment concept is available, but ultimately positive evidence is lacking for some manual therapies, pharmacological therapy, and neuromodulation, respectively.