Zusammenfassung
Schmerzhafte osteoporotische und pathologische Wirbelkörperfrakturen sind eine häufige Ursache für akute oder chronische Rückenschmerzen mit gravierenden Konsequenzen hinsichtlich Immobilität, reduzierter Lebensqualität, erhöhter Morbidität und Mortalität und erhöhtem Folgefrakturrisiko. Auch die besten verfügbaren evidenzbasierten Therapeutika können das Risiko für das Auftreten von Wirbelkörperfrakturen nur um etwa 50% senken, weshalb schmerzhafte Wirbelkörperfrakturen nicht völlig zu verhindern sind. Die Kyphoplastie als minimal-invasives osteoplastisches Verfahren ist eine kausale Schmerztherapie bei schmerzhaften Wirbelbrüchen. Die Indikationsstellung für dieses Verfahren erfordert eine interdisziplinäre Einzelfalldiskussion, um die technische Durchführbarkeit, die Sinnhaftigkeit der Indikation und die Einbettung der Durchführung dieses Verfahrens in das erforderliche multimodale Langzeittherapiekonzept sicherzustellen. Bei der Kyphoplastie wird durch die Verwendung eines Ballonkatheters versucht, den schmerzhaft eingebrochenen Wirbelkörper intern zu stabilisieren und gleichzeitig auch soweit möglich aufzurichten, was bei akuten Wirbelkörperfrakturen eher gelingt. Kontrollierte prospektive Studien belegen, dass es bei schmerzhaften osteoporotischen Wirbelbrüchen nach einer Kyphoplastie in Ergänzung zu dem medikamentös-internistischen Therapiekonzept zu einer langfristigen Schmerzreduktion, Reduktion des Medikamentenverbrauchs, größerer Mobilität und verbesserter Lebensqualität kommt.
Abstract
Painful osteoporotic and malignant vertebral fractures are frequent causes of chronic back pain with negative consequences regarding immobility, quality of life, morbidity, mortality, and fracture incidence. The best currently available evidence-based treatment reduces vertebral fracture risk but does not totally prevent follow-up fractures. Kyphoplasty is a causal treatment of pain by internal stabilization that prevents the ongoing pain of constant vertebral (micro-)fracture. The indication for this minimally invasive procedure requires interdisciplinary discussion of the individual case to guarantee technical feasibility, increase the likelihood that kyphoplasty will indeed reduce pain, and embed this procedure in the individual patient’s long-term therapeutic concept or treatment of painful vertebral metastases. In addition to internal stabilization of painful vertebral fractures, kyphoplasty seeks to restore lost vertebral height, which appears promising in acute and painful vertebral fractures. Available controlled prospective studies demonstrate long-term patient benefits in terms of pain reduction, mobility, and improved quality of life.
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Der korrespondierende Autor weist auf folgende Beziehungen hin: Die Autoren Profs. Kasperk, Nöldge und Meeder nehmen Vortrags- und Beratertätigkeiten für die Firma Medtronic wahr.
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Kasperk, C., Nöldge, G., Meeder, P. et al. Kyphoplastie. Chirurg 79, 944–955 (2008). https://doi.org/10.1007/s00104-008-1520-z
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DOI: https://doi.org/10.1007/s00104-008-1520-z