Der Chirurg

, Volume 79, Issue 10, pp 944–955 | Cite as

Kyphoplastie

Minimal-invasives Verfahren zur Versorgung schmerzhafter Wirbelkörperfrakturen
  • C. Kasperk
  • G. Nöldge
  • P. Meeder
  • P. Nawroth
  • F.X. Huber
Leitthema

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.

Schlüsselwörter

Kyphoplastie Wirbelkörperfrakturen Osteoporose Rückenschmerzen Metastasen 

Kyphoplasty

Method for minimally invasive treatment of painful vertebral fractures

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.

Keywords

Kyphoplasty Vertebral fracture Back pain Osteoporosis Metastases 

Literatur

  1. 1.
    Bellach B, Ellert U, Radoschewski M (2000) Epidemiologie des Schmerzes – Ergebnisse des Bundes-Gesundheitssurveys 1998. Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz 43: 424–443Google Scholar
  2. 2.
    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
  3. 3.
    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
  4. 4.
    Black D, Delmas P, Eastell R et al. (2007) Once yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 356: 1809–1822PubMedCrossRefGoogle Scholar
  5. 5.
    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 [Suppl II] 67: 56Google Scholar
  6. 6.
    Borgström F, Zethaerus N, Johnell O (2006) Costs and quality of life associated with osteoporosis related fractures in Sweden. Osteoporosis Int 17: 637–650CrossRefGoogle Scholar
  7. 7.
    Brenneman S, Barrett-Connor E, Sajjan S et al. (2006) Impact of recent fracture on health related quality of life in postmenopausal women. J Bone Min Res 21: 809–816CrossRefGoogle Scholar
  8. 8.
    Burger H, van aele P, Grashuis K et al. (1997) Vertebral deformities and functional impairment in men and women. J Bone Min Res 12: 152–157CrossRefGoogle Scholar
  9. 9.
    Center J, Nguyen T, Schneider D et al. (1999) Mortality after all myjor types of osteoporotic fracture in m en and women: an observational study. Lancet 353: 878–882PubMedCrossRefGoogle Scholar
  10. 10.
    Chen H, Wong C, Ho S et al. (2002) A lethal pulmonary embolism during percutaneous vertebroplasty. Anesth Analg 95: 1060–1062PubMedCrossRefGoogle Scholar
  11. 11.
    Chen Y, Tan T, Chen W et al. (2006) Intradural cement leakage. Spine 31: E379-E382PubMedCrossRefGoogle Scholar
  12. 12.
    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
  13. 13.
    EPOS group (2002) Incidence of vertebral fractures in Europe: results from the European prospective osteoporosis study (EPOS). J Bone Min Res 17: 716–724CrossRefGoogle 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 Min Res 18: 1664–1673CrossRefGoogle Scholar
  15. 15.
    Ettinger B, Black D, Nevitt M et al. (1992) Contribution of vertebral deformities to chronic back pain and disability. J Bone Min Res 7: 449–456Google Scholar
  16. 16.
    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
  17. 17.
    Felsenberg D, Wieland E, Hammermeister C et al. EVOS Gruppe (1998) Prävalenz der vertebralen Wirbelkörperdeformationen bei Frauen und Männern in Deutschland. Medizin Klinik [Suppl II] 93: 31–34Google Scholar
  18. 18.
    Grados F, Depriester C, Cayrolle G et al. (2000) Long term observations of vertebralosteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology 39: 1410–1414PubMedCrossRefGoogle Scholar
  19. 19.
    Grafe I, DaFonseca K, Hillmeier J et al. (2005) Reduction of pain and fracture incidence after kyphoplasty: 1 year outcome of a propective controlled trial of patients with primary osteoporosis. Osteoporosis Int 16: 2005–2012CrossRefGoogle Scholar
  20. 20.
    Grafe I, Nöldge G, Baier M et al. (2007) 3-year outcome after kyphoplasty in a prospective controlled trial role of initial bone edema and selection of cement type (PMMA vs. calciumphosphatcement). J Bone Min Res [Suppl 1] 22: S336,T416Google Scholar
  21. 21.
    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
  22. 22.
    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 Min Res 18: 1964.1969CrossRefGoogle Scholar
  23. 23.
    Haas H, Amling M, Baier M et al. (2008) Zur Anwendung der Ballon-Kyphoplasty/Vertebroplastie. Osteologie 17: 11–16Google Scholar
  24. 24.
    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
  25. 25.
    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
  26. 26.
    Harrington K (2001) Major neurological complications following percutaneous vertebroplasty with polymethylmetacrylate. J Boen Joint Surg 83A: 1070–1073Google Scholar
  27. 27.
    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
  28. 28.
    Huang C, Ross P, Wasnich R (1996) Vertebral fractures and other predictors of back pain among older women. J Bone Min Res 11: 1026–1032CrossRefGoogle Scholar
  29. 29.
    Huang M, Barrett-Connor E, Greendale G, Kado D (2006) Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo Study. J Bone Min Res 21: 419–423CrossRefGoogle Scholar
  30. 30.
    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
  31. 31.
    Kanis J, Johnell O, deLaet C et al. (2004) A meta-analysis of previous fracture and subsequent fracture risk. Bone 35: 375–382PubMedCrossRefGoogle Scholar
  32. 32.
    Kasperk C, Hillmeier J, Nöldge G et al. (2003) Kyphoplastie Konzept zur Behandlung schmerzhafter Wirbelkörperbrüche. Deutsches Ärzteblatt 100: 1748–1752Google Scholar
  33. 33.
    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 Min Res 20: 604–612CrossRefGoogle Scholar
  34. 34.
    Kasperk C, Baier M, Nöldge G (2007) An interdisciplinary approach to improve pain and mobility in patients with osteoporosis and painful vertebral fractures by kyphoplasty. J Bone Min Res [Suppl 1] 22: S505, WG26Google Scholar
  35. 35.
    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: 817–826CrossRefGoogle Scholar
  36. 36.
    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 Min Res 15: 721–739CrossRefGoogle Scholar
  37. 37.
    Koes B, van Tulder M, Thomas S (2006) Diagnosis and treatment of low back pain. BMJ 332: 1430–1434PubMedCrossRefGoogle Scholar
  38. 38.
    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 [Suppl 1] 11: 13–15Google Scholar
  39. 39.
    Ledlie J, Renfro M (2003) Balloon kyphoplasty: one year outcomes in vertebral body height restoration, chronic pain, and activity levels. J Neurosurg (Spine 1) 98: 36–42Google Scholar
  40. 40.
    Leidig-Bruckner G, Minne H, Schlaich C et al. (1997) Clinical grading of spinal osteoporosis: quality of life components and spinal deformit in women with chronic low back pain and women with vertebral osteoporosis. J Bone Min Res 12: 663–675CrossRefGoogle Scholar
  41. 41.
    Li J, Ahmad T, Spetea M et al. (2001) Bone innervation after fracture: a study in the rat. J Bone Min Res 16: 1505–1510CrossRefGoogle 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 dadiological 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(1): 155–166PubMedCrossRefGoogle Scholar
  50. 50.
    McKiernan F, Jensen R, Faciszewski T (2003) The dynamic facture mobility of vertebral compression fractures. J Bone Min Res 18: 24–29CrossRefGoogle Scholar
  51. 51.
    Meeder P, DaFonseca K, Hillmeier J et al. (2003) Kyphoplastei 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? Medizinische Klinik 98: 437–446PubMedCrossRefGoogle Scholar
  55. 55.
    Nevitt M, Ettinger B, Black D et al. (1998) The association of radiographically detected vertebral fractures with back pain and function: a prospective study. Ann Intern Med 128: 793–800PubMedGoogle Scholar
  56. 56.
    Nöldge G, DaFonseca K, Grafe I et al. (2006) Die Ballonkyphoplastie in der Behandlung des Rückenschmerzes. Der Radiologe 46: 506–512PubMedCrossRefGoogle Scholar
  57. 57.
    Pluijm S, Tromp A, Smit J (2000) Consequences of vertebral deformities in older men and women. J Bone Min Res 15: 1564–1572CrossRefGoogle Scholar
  58. 58.
    Pongchaiyakul C, Guyen N, Jones G et al. (2005) Asymptomatic vertebral deformity as a major risk factor for subsequent fractures and mortality: a long term prospective study. J Bone Min Res 20: 1349–1355CrossRefGoogle Scholar
  59. 59.
    Pott L, Wippermann B, Hussein S et al. (2005) PMMA. Lungenembolisation und postinterventionelle Anschlußfrakturen nach perkutaner Vertebroplastie. Orthopäde 34: 698–702PubMedCrossRefGoogle Scholar
  60. 60.
    Ratkliff J, Guyen T, Heiss J (2001) Root and spinal cord compression from methylmetacrylate vertebroplasty. Spine 26: E300–E302CrossRefGoogle Scholar
  61. 61.
    Seffinger M, Najm W, Mishra S et al. (2004) Reliability of spinal palpation for diagnosis of back and neck pain. Spien 29: E413–E425CrossRefGoogle Scholar
  62. 62.
    Seiler C, Knaebel H, Wente M et al. (2004) Plädoyer für mehr evidenzbasierte Chirurgie. Deutsches Ärzteblatt 101: 289–293Google Scholar
  63. 63.
    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
  64. 64.
    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
  65. 65.
    Silverman S (1992) The clinical consequences of vertebral compression fracture. Bone 13: 27–31CrossRefGoogle Scholar
  66. 66.
    Sornay-Rendu E, Munoz F, Garnero P et al. (2005) Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Min Res 20: 1813–1819CrossRefGoogle Scholar
  67. 67.
    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 Min Res 19: 1813–1820CrossRefGoogle Scholar
  68. 68.
    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
  69. 69.
    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 Min Res 19: 1172–1180CrossRefGoogle Scholar
  70. 70.
    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
  71. 71.
    Voggenreiter G (2005) Balloon kyphoplasty is effective in deformity correction of osteoporotic vertebral compression fractures. Spine 30: 2806–2812PubMedCrossRefGoogle Scholar
  72. 72.
    Von der Recke P, Hansen M, Hassager C (1999) The association between low bone mass at the menopause and cardiovascular mortality. Am J Med 106: 273–278CrossRefGoogle Scholar
  73. 73.
    Weißkopf M, Herlein S, Birnbaum K et al. (2003) Kyphoplastie – ein neues minimallinvasives Verfahren zur Aufrichtung und Stabilisierung von Wirbelkörpern. Z Orthop 141: 406–411PubMedCrossRefGoogle Scholar
  74. 74.
    Zerwekh J, Ruml L, Gottschalk F, Pak C (1998) The effects of twelve weeks of bed rest on bone histology, biochmechanical markers of bone turnover, and calcium homeostasis in eleven normal subjects. J Bone Min Res 13: 1594–1601CrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2008

Authors and Affiliations

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

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