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Minimal-invasive Stabilisierung osteoporotischer Wirbelkörpereinbrüche

Methodik und präinterventionelle Diagnostik

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Zusammenfassung

Zielsetzung

Minimal-invasive Stabilisierungen stellen eine Alternative zur bisherigen Behandlung osteoporotischer Wirbelfrakturen dar. Die Vertebroplastie und die Ballonkyphoplastik sind 2 Verfahren, um die Festigkeit der Wirbelkörper nach osteoporotischen Kompressionsfrakturen durch Einbringen von Knochenzement wieder herzustellen.

Material und Methodik

Die Vertebroplastie ist die ältere, technisch einfachere und kostengünstigere Technik, geht allerdings regelmäßig mit Zementaustritt einher. Die Ballonkyphoplastik ist die neuere kostenintensivere Technologie, mit der abgesehen von der Schmerzreduktion auch die Wiederherstellung des sagittalen Profils der Wirbelsäule angestrebt werden kann.

Ergebnisse

Mit der Ballonkyphoplastik konnten bei 101 frakturierten Wirbelkörpern die Höhe auf fast 90% des Sollwertes angehoben und die lokale Kyphose von 12 auf 7° vermindert werden. Die Schmerzen wurden—gemessen anhand einer 10-teiligen Skala—von 7,2 auf 2,5 reduziert. Der Oswestry disability index sank von 60 auf 26 Punkte. Dieser Effekt war auch noch 2 Jahre nach der Intervention nachweisbar. Bei 2% der Wirbelkörper trat Zement in den Epiduralraum aus. Bei 11% der Wirbelkörper wurden Frakturen der benachbarten Wirbelkörper innerhalb des 1. postoperativen Jahres beobachtet.

Schlussfolgerung

Bei exakter präinterventioneller Diagnostik und guter intraoperativer Bildgebung ist die Ballonkyphoplastik eine vielversprechende Anwendung.

Abstract

Purpose

Minimal invasive stabilizations represent a new alternative for the treatment of osteoporotic compression fractures. Vertebroplasty and balloon kyphoplasty are two methods to enhance the strength of osteoporotic vertebral bodies by the means of cement application.

Material and methods

Vertebroplasty is the older and technically easier method. The balloon kyphoplasty is the newer and more expensive method which does not only improve pain but also restores the sagittal profile of the spine.

Results

By balloon kyphoplasty the height of 101 fractured vertebral bodies could be increased up to 90% and the wedge decreased from 12 to 7 degrees. Pain was reduced from 7,2 to 2,5 points. The Oswestry disability index decreased from 60 to 26 points. This effects persisted over a period of two years. Cement leakage occurred in only 2% of vertebral bodies. Fractures of adjacent vertebral bodies were found in 11%.

Conclusion

Good preinterventional diagnostics and intraoperative imaging are necessary to make the balloon kyphoplasty a successful application.

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Grohs, J.G., Krepler, P. Minimal-invasive Stabilisierung osteoporotischer Wirbelkörpereinbrüche. Radiologe 44, 254–259 (2004). https://doi.org/10.1007/s00117-004-1020-1

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