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Vertebroplastie und Kyphoplastie bei osteoporotischen Wirbelkörperfrakturen: Gesicherte Kenntnisse, offene Fragen

Vertebroplasty and kyphoplasty in patients with osteoporotic fractures: secured knowledge and open questions

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Zusammenfassung

Die Zementoplastie, entweder als perkutane Vertebro- oder Kyphoplastie ausgeführt, hat sich als effiziente Technik für die Behandlung schmerzhafter Wirbelkörperfrakturen etabliert. Sie hat geringe Komplikationsraten, ist erfolgreich bei der Schmerzlinderung und verbessert die Mobilität und Lebensqualität der Patienten. Allerdings ist eine Reihe von Fragen noch offen oder Gegenstand einer kontroversen Debatte, so sind z. B. die Ergebnisse vieler biomechanischer Studien z. T. widersprüchlich. Die klinische Datenlage zur Frage der Anschlussfrakturen ist ebenfalls noch unzureichend, allerdings zeigt die Mehrheit der Studien keine erhöhte Rate von Anschlussfrakturen nach Therapie mit einer Zementoplastie im Vergleich zum natürlichen Verlauf von Patienten mit osteoporotischen Frakturen.

Die Kyphoplastie hat den Vorteil, die Höhe des Wirbelkörpers wieder herstellen bzw. den Kyphosewinkel reduzieren zu können, ohne dass dies zu unterschiedlichen klinischen Ergebnissen im Vergleich zur Vertebroplastie führt. Biomechanische Überlegungen, dass eine Wiederherstellung der normalen Form des Wirbelkörpers die Rate der Anschlussfrakturen vermindern könnte, bedürfen der wissenschaftlichen Untermauerung.

In unserer Klinik werden beide Methoden angewendet. Die Kyphoplastie erscheint uns indiziert, wenn die Höhe des anterioren Anteils des Wirbelkörpers um 1/3 gegenüber der Norm reduziert ist oder ein Kyphosewinkel von mehr als 15–20° vorliegt. Ziele der Therapie sind die Wiederherstellung der Form und die Reduktion des Kyphosewinkels. Dies kann allerdings nur bei Frakturen gelingen, die nicht älter als 3 Wochen sind. In allen anderen Fällen erfolgt eine Vertebroplastie.

Abstract

Cementoplasty, performed either as percutaneous vertebroplasty or kyphoplasty, has become well established as an effective technique to treat painful vertebral body fractures. It has low complication rates, is successful in alleviating pain, and improves the patients’ mobility and quality of life. A series of questions remain open though or are the subject of controversial debate; for example, the results of several biomechanical studies are in part contradictory. Clinical data on subsequent fractures are also still inadequate, although the majority of studies show no elevated rate of subsequent fractures following treatment with cementoplasty in comparison to the natural course in patients with osteoporotic fractures.

Kyphoplasty has the advantage of being able to restore the vertebral body height or reduce the kyphosis angle without leading to different clinical outcomes in comparison to vertebroplasty. Biomechanical considerations on whether restoration of the vertebral body’s normal shape could reduce the rate of subsequent fractures still need scientific substantiation.

Both surgical methods are employed in our clinic. Kyphoplasty seems to us to be indicated when the height of the anterior portion of the vertebral body is reduced by one-third compared to the norm or a kyphosis angle of more than 15–20° is present. The goals of therapy are restoring the shape and reducing the kyphosis angle. This can only succeed, however, in fractures that are not older than 3 weeks. In all other cases vertebroplasty is performed.

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Bohndorf, K., Fessl, R. Vertebroplastie und Kyphoplastie bei osteoporotischen Wirbelkörperfrakturen: Gesicherte Kenntnisse, offene Fragen. Radiologe 46, 881–892 (2006). https://doi.org/10.1007/s00117-006-1391-6

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