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Indikationen und Ergebnisse der Kypho- und Vertebroplastie

Indications and results of kypho- and vertebroplasty

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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.

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.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin:

Profs. Kasperk, Meeder und Nöldge führen für die Firma Medtronic Referenten- und Beratungstätigkeiten durch.

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Authors and Affiliations

  1. Sektion Osteologie, Abteilung Innere Medizin I und Klinische Chemie, Medizinische Universitätsklinik, Ruprecht-Karls-Universität, Im Neuenheimer Feld 410, 69120, Heidelberg, Deutschland

    C. Kasperk & I. Grafe

  2. Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum, Heidelberg, Deutschland

    G. Nöldge

  3. Sektion Unfall- und Wiederherstellungschirurgie, Chirurgische Universitätsklinik, Heidelberg, Deutschland

    P. Meeder & F. Huber

  4. Abteilung Innere I und Klinische Chemie, Medizinische Universitätsklinik, Heidelberg, Deutschland

    P. Nawroth

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  1. C. Kasperk
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  2. G. Nöldge
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  3. I. Grafe
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  4. P. Meeder
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  5. F. Huber
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Correspondence to C. Kasperk.

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Kasperk, C., Nöldge, G., Grafe, I. et al. Indikationen und Ergebnisse der Kypho- und Vertebroplastie. Internist 49, 1206–1218 (2008). https://doi.org/10.1007/s00108-008-2116-x

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