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Zementaugmentation bei Wirbelmetastasen (Vertebro- und Kyphoplastie)

Cement injection for spinal metastases (vertebroplasty and kyphoplasty)

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Zusammenfassung

Pathologische Wirbelfrakturen bei Metastasen oder im Rahmen eines multiplen Myeloms können mittels einer Zementaugmentation (Vertebro- oder Kyphoplastie) effizient stabilisiert werden. Die Indikationsstellung beschränkt sich auf Läsionen im Wirbelkörper, sobald die posterioren Elemente involviert sind genügt eine Zementierung nicht mehr, ebenso wenn eine Spinalkanaleinengung/Neurokompression vorhanden ist. Technisch wird gleich verfahren wie bei der osteoporotischen Fraktur – das Extravasationsrisiko ist aber erheblich größer und die klinischen Ergebnisse sind nicht so uniform positiv wie bei Osteoporosefrakturen. Die Zementaugmentation per se ist keine Tumorbehandlung sondern eine Stabilisierung des Wirbels. Osteolysen ohne mechanische Kompromittierung brauchen keine Augmentation. Die Patientenbetreuung sollte interdisziplinär vernetzt erfolgen.

Abstract

Osteolytic lesions of the spine (metastasis, myeloma) can be treated extremely efficiently by percutaneous cement injection. The treatment should be restricted to osteolytic lesions of the vertebral body, and only if a relevant mechanical deterioration is present. If the pedicles and/or the lamina are involved and if there is compression of the spinal canal, the treatment is no longer appropriate. The surgical technique is similar to the treatment of osteoporotic fractures; however, there is definitely a higher risk for cement leakage and the clinical outcome is not as predictable as in osteoporotic fracture treatment. It is important to realize that cement injection per se has no impact on the tumor itself, but provides stability to the vertebral body. An osteolytic lesion without mechanical compromise does not need a vertebroplasty. Patients with tumorous lesions of the spine should be followed by an interdisciplinary team of spine surgeon, oncologist and radio-oncologist.

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  1. Klinik für Orthopädische Chirurgie und Spine Research Center, Inselspital, Universität Bern, 3010, Bern, Schweiz

    P.F. Heini

  2. Universitätsklinik für Allgemeine Innere Medizin, Inselspital, Bern, Schweiz

    S. Pfäffli

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  1. P.F. Heini
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  2. S. Pfäffli
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Correspondence to P.F. Heini.

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Heini, P., Pfäffli, S. Zementaugmentation bei Wirbelmetastasen (Vertebro- und Kyphoplastie). Orthopäde 38, 335–342 (2009). https://doi.org/10.1007/s00132-008-1377-3

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  • DOI: https://doi.org/10.1007/s00132-008-1377-3

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