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Komplikationen in der Vertebroplastie

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Zusammenfassung

Die perkutane Vertebroplastie wurde 1984 von Galibert et al. zur Therapie von Hämangiomen an der Wirbelsäule entwickelt. Die Indikation erweiterte sich in der Folge auf osteoporotische Kompressionsfrakturen, sowie osteolytische Herde unterschiedlicher Entität.

Mit der steigenden Anzahl an Anwendungen insbesondere durch die Fachdisziplinen Orthopädie, Traumatologie, Neurochirurgie und Radiologie kam es auch zu einer Zunahme an Komplikationen. In den vergangenen 3 Jahren findet sich in der Literatur eine stetig steigende Anzahl an Kasuistiken über unterschiedlichste Komplikationen, deren Entstehung, sowie das nachfolgende Therapiemanagement. Die Komplikationsliste reicht von harmlosen paravertebralen Zementaustritten und temporären kardiopulmonalen Ereignissen über Lungenembolien mit letalem Ausgang bis hin zu schwerwiegenden neurologischen Ausfallerscheinungen im Sinne einer Paraplegie oder Radikulopathie.

Dieser Artikel soll einerseits die in der Literatur dargestellten Komplikationen zusammenfassen, das derzeit gültige Therapiemanagement aufzeigen und Möglichkeiten beschreiben Komplikationen zu vermeiden bzw. deren Auftreten zu minimieren. Radiologische Befunde möglicher unerwünschter Zementaustritte aus dem eigenen Patientengut werden aufgezeigt.

Abstract

Percutaneous vertebroplasty was first introduced in 1984 by Galibert et al. for the treatment of hemangiomas in the spine. The current indications for vertebroplasty also include compression fractures due to osteoporosis as well as osteolytic metastases and spinal myeloma lesions.

With the numbers of percutaneous vertebroplasty performed by orthopedic and trauma surgeons, neurosurgeons, and radiologists steadily increasing, complications have also risen. Over the last 3 years an increasing number of cases with varying complications, their genesis, and their management have been reported in the literature. Complications include asymptomatic cement leakage, cardiovascular effects, embolism with lethal outcome as well as severe neurological deficits.

This article presents a review of the complications reported in the literature, strategies for preventing possible complications as well as current concepts in therapy management. Several of our cases with cement leakages are presented.

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Correspondence to M. A. Rauschmann.

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Rauschmann, M.A., von Stechow, D., Thomann, KD. et al. Komplikationen in der Vertebroplastie. Orthopäde 33, 40–47 (2004). https://doi.org/10.1007/s00132-003-0573-4

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