Der Internist

, Volume 49, Issue 10, pp 1206–1218 | Cite as

Indikationen und Ergebnisse der Kypho- und Vertebroplastie

  • C. Kasperk
  • G. Nöldge
  • I. Grafe
  • P. Meeder
  • F. Huber
  • P. Nawroth
Schwerpunkt

Zusammenfassung

Auch die besten verfügbaren evidenzbasierten Therapeutika können das Risiko für das Auftreten von Wirbelkörperfrakturen nur senken, weshalb schmerzhafte osteoporotische und pathologische Wirbelkörperfrakturen nicht völlig zu verhindern sind. Kyphoplastie und Vertebroplastie als minimal-invasive osteoplastische Verfahren sind ursächliche Schmerztherapieverfahren bei schmerzhaften Wirbelsinterungen. Die Indikationsstellung für eines dieser Verfahren erfordert eine interdisziplinäre Einzelfalldiskussion, um die technische Durchführbarkeit, die Sinnhaftigkeit der Indikation und die Einbettung der Durchführung dieser Verfahren in das erforderliche multimodale Langzeittherapiekonzept sicherzustellen. Bei der Kyphoplastie wird durch die Verwendung eines Ballonkatheters stets versucht, den schmerzhaft eingebrochenen Wirbelkörper nicht nur intern zu stabilisieren, sondern gleichzeitig auch aufzurichten, was eher bei akuten Wirbelkörperfrakturen gelingt. Bei der Vertebroplastie erfolgt eine interne Stabilisierung des Wirbelbruchs, wobei verfahrensbedingt häufiger als bei der Kyphoplastie ungewollte Implantatmaterialaustritte aus dem behandelten Wirbelkörper auftreten. Kontrollierte Studien belegen bisher nur für die Kyphoplastie eine langfristige Schmerzreduktion und eine verbesserte Mobilität und Lebensqualität.

Schlüsselwörter

Kyphoplastie Vertebroplastie Wirbelkörperfrakturen Osteoporose Rückenschmerzen 

Indications and results of kypho- and vertebroplasty

Abstract

The best currently available evidence based treatment reduces vertebral fracture risk but does not totally prevent osteoporotic and malignant follow-up fractures. Kyphoplasty and vertebroplasty are options of a causal treatment to reduce pain by internal stabilization of fractured vertebrae. The indication for these minimal invasive procedures requires an interdisciplinary discussion of the individual case to guarantee technical feasibility, to increase the likelihood that these procedures will indeed reduce pain and to embed these procedures into the long term therapeutic concept of every single patient. In addition to internal stabilization of a painfully fractured vertebra kyphoplasty also seeks to restore lost vertebral height which appears promising in acute vertebral fractures. Due to the procedure there are more cement leakages after vertebroplasty. Available controlled prospective studies demonstrate only for kyphoplasty a long-term benefit for the patient in terms of pain reduction, increased mobility and improved quality of life.

Keywords

Kyphoplasty Vertebroplasty Vertebral fracture Back pain Osteoporosis 

Literatur

  1. 1.
    Baroud G, Heini P, Nemes J et al. (2003) Biomechanical explanation of adjacent fractures following vertebroplasty. Radiology 229: 606–607PubMedCrossRefGoogle Scholar
  2. 2.
    Bellach B, Ellert U, Radoschewski M (2000) Epidemiologie des Schmerzes – Ergebnisse des Bundes-Gesundheitssurveys 1998. Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 43: 424–443CrossRefGoogle Scholar
  3. 3.
    Berlemann U, Ferguson S, Nolte L, Heini P (2002) Adjacent vertebral failure after vertebroplasty. J Bone Joint Surg Br 84: 748–752PubMedCrossRefGoogle Scholar
  4. 4.
    Black D, Cummings S, Karpf D et al. (1996) Randomized trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Lancet 348: 1535–1541PubMedCrossRefGoogle Scholar
  5. 5.
    Black D, Bilezikian J, Ensrud K et al. (2005) One year of alendronate after one year of parathyroid hormone 1–84 for osteoporosis. N Engl J Med 353: 555–565PubMedCrossRefGoogle Scholar
  6. 6.
    Black D, Delmas P, Eastell R et al. (2007) Once yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356: 1809–1818PubMedCrossRefGoogle Scholar
  7. 7.
    Boonen S, Wardlaw D, Bastian L, van Meirhaege J (2008) A randomized trial of balloon kyphoplasty and nonsurgical care for patients with acute vertebral compression fractures one year results. Ann Rheum Dis 67: 56Google Scholar
  8. 8.
    Chen H, Wong C, Ho S et al. (2002) A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg 95: 1060–1062PubMedCrossRefGoogle Scholar
  9. 9.
    Chen Y, Tan T, Chen W et al. (2006) Intradural cement leakage. Spine 31: E379–E382PubMedCrossRefGoogle Scholar
  10. 10.
    Chen P, Glass E, Bouxsein M et al. (2006) The influence of location, number, and severity of prevalent osteoporotic vertebral fracture on adjacent vertebral fracture risk. Osteoporosis Int 17: S140Google Scholar
  11. 11.
    Delmas P, Genant H, Crans G et al. (2003) Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures results from the MORE trial. Bone 33: 522–532PubMedCrossRefGoogle Scholar
  12. 12.
    de Negri P, Tirri T, Paternoster G, Modano P (2007) Treatment of painful osteoporotic or traumatic vertebral compression fractures by percutaneous vertebral augmentation procedures a nonrandomized comparison between vertebroplasty and kyphoplasty. Clin J Pain 23: 425–430CrossRefGoogle Scholar
  13. 13.
    Diamond T, Champion B, Clark W (2003) Management of acute osteoporotic vertebral fractures a nonrandomized trialcomparing percutaneous vertebroplasty with conservative therapy. Am J Med 114: 257–265PubMedCrossRefGoogle Scholar
  14. 14.
    EPOS Group (2003) Determinants of the size of incident vertebral deformities in European men and women in the sixth to ninth decade of age the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res 18: 1664–1673CrossRefGoogle Scholar
  15. 15.
    Ettinger B, Black D, Mitlak B et al. (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene results from a 3 year randomized clinical trial. JAMA 282: 637–645PubMedCrossRefGoogle Scholar
  16. 16.
    Fourney D, Schomer D, Nader R et al. (2003) Percutaneous vertebroplasty and kyphoplasty for painful vertebral body fractures in cancer patients. J Neurosurg (Suppl) 98: 21–30Google Scholar
  17. 17.
    Grados F, Depriester C, Cayrolle G et al. (2000) Long term observations of vertebralosteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology 39: 1410–1414PubMedCrossRefGoogle Scholar
  18. 18.
    Grafe I, DaFonseca K, Hillmeier J et al. (2005) Reduction of pain and fracture incidence after kyphoplasty: 1 year outcome of a prospective controlled trial of patients with primary osteoporosis. Osteoporosis Int 16: 2005–2012CrossRefGoogle Scholar
  19. 19.
    Grafe I, Baier M, Nöldge G et al. (2008) Calcium-phosphate and polymethylmetacrylate cement in long term outcome after kyphoplasty of painful osteoporotic vertebral fractures. Spine 33: 1284–1290PubMedCrossRefGoogle Scholar
  20. 20.
    Grohs J, Matzner M, Trieb K, Krepler P (2005) Minimal invasive stabilization of osteoporotic vertebral fractures a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty. J Spinal Disord Tech 18: 238–242PubMedGoogle Scholar
  21. 21.
    Gustavsson A, Olsson T, Nordström P (2003) Rapid loss of bone mineral density of the femoral neck after cessation of ice hockey training. J Bone Miner Res 18: 1964–1969PubMedCrossRefGoogle Scholar
  22. 22.
    Haas H, Amling M, Baier M et al. (2008) Zur Anwendung der Ballon-Kyphoplasty/Vertebroplastie. Osteologie 17: 11–16Google Scholar
  23. 23.
    Harris S, Wats N, Genant H et al. (1999) Effects of risedronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis. JAMA 282: 1344–1352PubMedCrossRefGoogle Scholar
  24. 24.
    Häussler B, Gothe H, Göl D et al. (2007) Epidemiology, treatment and costs of osteoporosis in Germany – the BoneEVA study. Osteoporosis Int 18: 77–84CrossRefGoogle Scholar
  25. 25.
    Harrington K (2001) Major neurological complications following percutaneous vertebroplasty with polymethylmetacrylate. J Bone Joint Surg Am 83: 1070–1073PubMedGoogle Scholar
  26. 26.
    Hestbaek L, Leboeuf-Yde C, Manniche C (2003) Low back pain what is the long term course? A review of studies of general patient populations. Eur Spine J 12: 149–165PubMedGoogle Scholar
  27. 27.
    Helmberger T, Bohndorff K, Hierholzer J et al. (2003) Leitlinien der Deutschen Röntgengesellschaft zur Vertebroplastie. Radiologe 43: 703–708PubMedCrossRefGoogle Scholar
  28. 28.
    Hillmeier J, Grafe I, DaFonseca K et al. (2004) Die Wertigkeit der Ballonkyphoplastie bei der osteoporotischen Wirbelkörperfraktur. Orthopäde 33: 893–904PubMedGoogle Scholar
  29. 29.
    Huang C, Ross P, Wasnich R (1996) Vertebral fractures and other predictors of back pain among older women. J Bone Miner Res 11: 1026–1032PubMedGoogle Scholar
  30. 30.
    Huang M, Barrett-Connor E, Greendale G, Kado D (2006) Hyperkyphotic posture and risk of future osteoporotic fractures the Rancho Bernardo Study. J Bone Miner Res 21419–21423Google Scholar
  31. 31.
    Johnell O, Oden A, Caulin F, Kanis J (2001) Acute and long term increase in fracture risk after hospitalization for vertebral fracture. Osteoporosis Int 12: 207–214CrossRefGoogle Scholar
  32. 32.
    Kanis J, Johnell O, deLaet C et al. (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35: 375–382PubMedCrossRefGoogle Scholar
  33. 33.
    Kasperk C, Hillmeier J, Nöldge G et al. (2003) Kyphoplastie – Konzept zur Behandlung schmerzhafter Wirbelkörperbrüche. Dtsch Ärztebl 100: 1748–1752Google Scholar
  34. 34.
    Kasperk C, Hillmeier J, Nöldge G et al. (2005) Treatment of painful vertebral fractures by kyphoplasty in patients with primary osteoporosis: a prospective nonrandomized controlled trial. J Bone Miner Res 20: 604–612PubMedCrossRefGoogle Scholar
  35. 35.
    Kasperk C, Grafe I, Baier M et al. (2007) 3-year outcome after kyphoplasty in a prospective controlled trial – role of initial edema and selection of cement type (PMMA vs. calciumphosphatcement). Congress of the American Society for Bone and Mineral Research, Honolulu, HawaiiGoogle Scholar
  36. 36.
    Khanna A, Reinhardt M, Togawa D, Lieberman I (2006) Functional outcomes of kyphoplasty for the treatment of osteoporotic and osteolytic vertebral compression fractures. Osteoporosis Int 17: 817–818CrossRefGoogle Scholar
  37. 37.
    Klotzbuecher C, Ross P, Landsman P et al. (2000) Patients with prior fractures have an increased risk of future fractures a summary of the literature and statistical synthesis. J Bone Miner Res 15: 721–739PubMedCrossRefGoogle Scholar
  38. 38.
    Koes B, van Tulder M, Thomas S (2006) Diagnosis and treatment of low back pain. BMJ 332: 1430–1434PubMedCrossRefGoogle Scholar
  39. 39.
    Komp M, Ruetten S, Godolias G (2004) Minimal-invasive Therapie der funktionell instabilen osteoporotischen Wirbelkörperfraktur mittels Kyphoplastie prospektive Vergleichsstudie von 19 operierten und 17 konservativ behandelten Patienten. J Miner Stoffwechs 11 (Suppl): 13–15Google Scholar
  40. 40.
    Ledlie J, Renfro M (2003) Balloon kyphoplasty one year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg 98 (Suppl): 36–42PubMedGoogle Scholar
  41. 41.
    Li J, Ahmad T, Spetea M et al. (2001) Bone innervation after fracture a study in the rat. J Bone Miner Res 16: 1505–1510PubMedCrossRefGoogle Scholar
  42. 42.
    Li C, Majeska R, Laudier D et al. (2005) High dose risedronate treatment partially preserves cancellous bone mass and microarchitecture during long term disuse. Bone 37: 287–295CrossRefGoogle Scholar
  43. 43.
    Liberman U, Weiss S, Bröll J et. al. (1995) Effect of oral alednronate on bone mineral density and the incidence of fractures in potmenopausal osteoporosis. N Engl J Med 333: 1437–1443PubMedCrossRefGoogle Scholar
  44. 44.
    Libicher M, Hillmeier J, Liegibel U et al. (2006) Osseous integration of calcium phosphate in osteoporotic vertebral fractures after kyphoplasty: initial results from a clinical and experimental pilot study. Osteoporosis Int 17: 1208–1215CrossRefGoogle Scholar
  45. 45.
    Libicher M, Appelt A, Berger I et al. (2007) The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17: 2248–2252PubMedCrossRefGoogle Scholar
  46. 46.
    Lieberman I, Dudeney S, Reinhardt M, Bell G (2001) Initial outcome and efficacy of kyphoplasty in the treatment of painful osteoporotic vertebral compression frcatures. Spine 26: 1631–1638PubMedCrossRefGoogle Scholar
  47. 47.
    Lindsay R, Silvermann S, Cooper C et al. (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285: 320–323PubMedCrossRefGoogle Scholar
  48. 48.
    Lunt M, O’Neill T, Felsenberg D et al. (2003) Characteristics of a prevalent vertebral deformity predict subsequent vertebral fracture: results from the European prospective osteoporosis study (EPOS). Bone 33: 505–513PubMedCrossRefGoogle Scholar
  49. 49.
    Mach D, Rogers S, Sabino M et al. (2002) Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience 113: 155–166PubMedCrossRefGoogle Scholar
  50. 50.
    McKiernan F, Jensen R, Faciszewski T (2003) The dynamic facture mobility of vertebral compression fractures. J Bone Miner Res 18: 24–29PubMedCrossRefGoogle Scholar
  51. 51.
    Meeder P, DaFonseca K, Hillmeier J et al. (2003) Kyphoplastie und Vertebroplastie bei Frakturen im hohen Lebensalter. Chirurg 74: 994–999PubMedCrossRefGoogle Scholar
  52. 52.
    Meunier P, Roux C, Seeman E et al. (2004) The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis. N Engl J Med 350: 459–468PubMedCrossRefGoogle Scholar
  53. 53.
    Mirovsky Y, Anekstein Y, Shalmion E et al. (2006) Intradiscal cement leak following percutaneous vertebroplasty. Spine 31: 1120–1124PubMedCrossRefGoogle Scholar
  54. 54.
    Nawroth P, Pirzer R, Fohr B et al. (2003) Osteoporose und koronare Herzkrankheit – zwei Seiten der gleichen Münze? Med Klin 98: 437–446CrossRefGoogle Scholar
  55. 55.
    Nöldge G, DaFonseca K, Grafe I et al. (2006) Die Ballonkyphoplastie in der Behandlung des Rückenschmerzes. Radiologe 46: 506–512PubMedCrossRefGoogle Scholar
  56. 56.
    Pott L, Wippermann B, Hussein S et al. (2005) PMMA. Lungenembolisation und postinterventionelle Anschlußfrakturen nach perkutaner Vertebroplastie. Orthopäde 34: 698–702PubMedCrossRefGoogle Scholar
  57. 57.
    Ratkliff J guyen T, Heiss J (2001) Root and spinal cord compression from methylmetacrylate vertebroplasty. Spine 26: E300–E302CrossRefGoogle Scholar
  58. 58.
    Seffinger M, Najm W, Mishra S et al. (2004) Reliability of spinal palpation for diagnosis of back and neck pain. Spine 29: E413–E425PubMedCrossRefGoogle Scholar
  59. 59.
    Seiler C, Knaebel H, Wente M et al. (2004) Plädoyer für mehr evidenzbasierte Chirurgie. Dtsch Ärztebl 101: 289–293Google Scholar
  60. 60.
    Serre C, Farlay D, Delmas P, Chenu C (1999) Evidence for a dense and intimate innervation of the bone tissue, including glutamate containing fibers. Bone 25: 623–629PubMedCrossRefGoogle Scholar
  61. 61.
    Shindle M, Gardner M, Koob J et al. (2006) Vertebral height restoration in osteoporotic compression fractures kyphoplasty balloon tamp is superior to postural correction alone. Osteoporosis Int 17: 1815–1819CrossRefGoogle Scholar
  62. 62.
    Sornay-Rendu E, Munoz F, Garnero P et al. (2005) Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res 20: 1813–1819PubMedCrossRefGoogle Scholar
  63. 63.
    Tanaka S, Sakai A, Otome H et al. (2004) Skeletal unloading alleviates the anabolic action of intermittent PTH(1–34) in mouse tibia in association with inhibition of PTH-induced increase in c-fos mRNA in bone marrow cells. J Bone Miner Res 19: 1813–1820PubMedCrossRefGoogle Scholar
  64. 64.
    Taylor R, Taylor R, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures. A comparative systematic review of efficacy and safety. Spine 31: 2747–2755PubMedCrossRefGoogle Scholar
  65. 65.
    Trout A, Kallmes D, Kaufmann T (2006a) New fractures after vertebroplasty adjacent fractures occur significantly sooner. Am J Neuroradiol 27: 217–223PubMedGoogle Scholar
  66. 66.
    Trout A, Kallmes D, Layton K et al. (2006b) Vertebral endplate fractures an indicator of the abnormal forces generated in the spine after vertebroplasty. J Bone Miner Res 21: 1797–1180PubMedCrossRefGoogle Scholar
  67. 67.
    Uppin A, Hirsch J, Centenera L et al. (2003) Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226: 119–124PubMedCrossRefGoogle Scholar
  68. 68.
    Van der Klift M, de Laet C, McCloskey E et al. (2004) Risk factors for incident vertebral fractures in men and women: the Rotterdam study. J Bone Miner Res 19: 1172–1180CrossRefGoogle Scholar
  69. 69.
    Van Helden S, Cals J, Kessels F et al. (2006) Risk of new clinical fractures within 2 years following a fracture. Osteoporosis Int 17: 348–354CrossRefGoogle Scholar
  70. 70.
    Voormolen M, Lohle P, Juttmann J et al. (2006) The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 17: 71–76PubMedCrossRefGoogle Scholar
  71. 71.
    Voormolen M, Mali W, Lohle P et al. (2007) Percutaneous vertebroplasty compared with optimal pain medication treatment: short term clinical outcome of patients with subacute or chronic painful osteoporotic vertebral compression fractures. The VERTOS Study. AJNR Am J Neuroradiol 28: 555–560PubMedGoogle Scholar
  72. 72.
    Weißkopf M, Herlein S, Birnbaum K et al. (2003) Kyphoplastie – ein neues minimalinvasives Verfahren zur Aufrichtung und Stabilisierung von Wirbelkörpern. Z Orthop 141: 406–411PubMedCrossRefGoogle Scholar
  73. 73.
    Zerwekh J, Ruml L, Gottschalk F, Pak C (1998) The effects of twelve weeks of bed rest on bone histology, biochmeical amrkers of boen turnover, and calcium homeostasis in eleven normal subjects. J Bone Miner Res 13: 1594–1516PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

  • C. Kasperk
    • 1
  • G. Nöldge
    • 2
  • I. Grafe
    • 1
  • P. Meeder
    • 3
  • F. Huber
    • 3
  • P. Nawroth
    • 4
  1. 1.Sektion Osteologie, Abteilung Innere Medizin I und Klinische ChemieMedizinische Universitätsklinik, Ruprecht-Karls-UniversitätHeidelbergDeutschland
  2. 2.Abteilung für Diagnostische und Interventionelle RadiologieUniversitätsklinikumHeidelbergDeutschland
  3. 3.Sektion Unfall- und WiederherstellungschirurgieChirurgische UniversitätsklinikHeidelbergDeutschland
  4. 4.Abteilung Innere I und Klinische ChemieMedizinische UniversitätsklinikHeidelbergDeutschland

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