Der Radiologe

, Volume 46, Issue 6, pp 495–505 | Cite as

Vertebroplastie zur Therapie des Rückenschmerzes

  • C. G. Trumm
  • T. F. Jakobs
  • C. J. Zech
  • C. Weber
  • M. F. Reiser
  • R.-T. Hoffmann
Rückenschmerz: Diagnostik und Intervention

Zusammenfassung

Hintergrund

Die perkutane Vertebroplastie (PVP) stellt bei osteoporotischen Wirbelkörperfrakturen (WKF) und Osteolysen der Wirbelsäule eine minimalinvasive Behandlungsmöglichkeit dar, die zunehmend an Bedeutung gewinnt. In diesem Beitrag sollen Indikationsstellung, periinterventionelle Bildgebung, Technik und klinische Ergebnisse der PVP dargestellt werden.

Material und Methoden

Gemäß dem „Interdisziplinären Konsensuspapier zur Vertebro- und Kyphoplastie“ der deutschen Fachgesellschaften sowie den Leitlinien der CIRSE aus dem Jahr 2005 werden die aktuellen Richtlinien zur Durchführung der PVP erläutert. Die Ergebnisse einer eigenen Studie werden Komplikationsraten und klinischen Ergebnissen in der Literatur gegenübergestellt.

Ergebnisse

Die Indikation zur PVP besteht bei schmerzhaften osteoporotischen WKF und Wirbelkörperosteolysen durch Metastasen und das multiple Myelom. Absolute Kontraindikationen sind v. a. asymptomatische WKF, eine Beschwerdelinderung unter medikamentöser Therapie, therapierefraktäre Koagulopathien, Allergien gegen Zementbestandteile und aktive Infektionen. Zur Abschätzung des Frakturalters, Ausschluss anderer Schmerzursachen und Beurteilung der Wirbelkörperhinterkante sind vor der PVP eine MRT bzw. CT indiziert. Eine qualitativ hochwertige mono- oder biplanare Fluoroskopie – möglichst in Kombination mit der CT(-Fluoroskopie) – sind bei der PVP erforderlich, um das Risiko von Zementleckagen zu minimieren. Bei 86–92% der Patienten wird durch die PVP eine deutliche Schmerzreduktion (mittlere Abnahme von 6,1 Punkten [VAS]) erreicht. Eine eigene Studie mit 58 behandelten Patienten (mittlerer Beobachtungszeitraum 323+/−99 Tage) zeigte in 77% der Fälle eine deutliche Beschwerdelinderung (−5,7 Punkte [VAS]).

Schlussfolgerung

Die PVP ermöglicht bei akutem und chronischem Rückenschmerz durch osteoporotische WKF und tumorbedingte Osteolysen eine sichere und effektive minimalinvasive Therapie zur Stabilisierung und Schmerzreduktion.

Schlüsselwörter

Perkutane Vertebroplastie Rückenschmerz Wirbelkörperfraktur Osteoporose Tumor 

Vertebroplasty in the treatment of back pain

Abstract

Background

Percutaneous vertebroplasty (PVP) represents a minimally invasive option which is gaining in importance for the treatment of vertebral compression fractures (VCF) and osteolysis of the spine. This article describes the indications for its use, peri-interventional imaging, technique, and results of PVP.

Material and methods

The current guidelines for performance of PVP are explained in accordance with the “Interdisciplinary Consensus Paper on Vertebroplasty and Kyphoplasty” of the German Professional Associations and the 2005 CIRSE Guidelines. The results of our own study carried out in 2002 are compared to the complication rates and clinical outcomes reported in the literature.

Results

Painful osteoporotic VCF and osteolysis within the vertebral body due to metastases and multiple myeloma are indications for PVP. Absolute contraindications are, in particular, asymptomatic VCF, alleviation of pain by drug treatment, therapy-refractory coagulopathies, allergies to cement components, and active infections. MRI or CT is indicated before undertaking PVP to assess the fracture age, to exclude other causes of pain, and to evaluate the posterior edge of the vertebral body. High-quality mono- or biplanar fluoroscopy – preferably in combination with CT (fluoroscopy) – is necessary for PVP to minimize the risk of cement leakage. A clear reduction in pain [mean reduction of 6.1 points (VAS)] is achieved in 86–92% of the patients with PVP. Our own study treating 58 patients (mean follow-up 323±99 days) revealed a clear alleviation of pain in 77% [−5.7 points (VAS)].

Conclusion

PVP constitutes a safe and effective minimally invasive treatment approach to stabilize and reduce acute and chronic back pain due to osteoporotic VCF and tumor-associated osteolysis.

Keywords

Percutaneous vertebroplasty Back pain Vertebral compression fracture Osteoporosis Tumor 

Notes

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

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Copyright information

© Springer Medizin Verlag 2006

Authors and Affiliations

  • C. G. Trumm
    • 1
  • T. F. Jakobs
    • 1
  • C. J. Zech
    • 1
  • C. Weber
    • 1
  • M. F. Reiser
    • 1
  • R.-T. Hoffmann
    • 1
  1. 1.Institut für Klinische RadiologieKlinikum Großhadern der Ludwig-Maximilians-UniversitätMünchen

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