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Osteoporotische Wirbelkörperfrakturen der thorakolumbalen Wirbelsäule

Diagnostik und Behandlungsstrategien

Osteoporotic vertebral body fractures of the thoracolumbar spine

Diagnostics and therapeutic strategies

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Zusammenfassung

Thorakolumbale Wirbelkörperfrakturen können bei entsprechender Osteoporose bereits ohne relevantes Unfallereignis auftreten. Initial steht die korrekte Diagnostik, das Erkennen frischer Wirbelkörperläsionen unter Beurteilung der Stabilität, im Vordergrund. Ziel der Therapie ist es, eine möglichst rasche und schmerzarme Mobilisation unter Erhalt des physiologischen Wirbelsäulenalignments zu erreichen. Dementsprechend besitzt bei entsprechend stabiler Frakturmorphologie das konservative Management oberste Priorität. Im Falle von Schmerzpersistenz sowie Nachsinterungstendenz kommen minimal-invasive Zementaugmentationsverfahren zum Einsatz. Instabile Frakturformen benötigen demgegenüber eine 360°-Versorgung im Sinne einer Hybridstabilisierung. Insbesondere bei Revisionseingriffen sind aber aufwendige und langstreckige Verfahren erforderlich. Dabei sollte die Instrumentierung unbedingt über den Scheitelpunkt der Kyphose hinausgehen.

Abstract

In cases of severe osteoporosis vertebral body fractures of the thoracolumbar spine can occur without any relevant trauma. Initially, a standardized diagnostic algorithm is recommended to detect acute vertebral body fractures and to be able to interpret the individual fracture stability. Aim of the therapy is to assure a relatively pain-free mobilization while maintaining vertebral spine alignment. A conservative therapy concept is initiated in patients with stable fractures. In cases of persistent pain, reduced mobility or increased kyphotic misalignment minimally invasive cement augmented therapy strategies are chosen. In cases of unstable fracture morphology a more complex therapy concept has to be chosen such as hybrid stabilization. A great deal of experience is needed for revision surgery. In such cases reconstructive, multi-segmental techniques might be necessary and the instrumentation should surpass the apex of kyphosis.

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Authors and Affiliations

  1. Klinik und Poliklinik für Unfall-, Wiederherstellungs- und Plastische Chirurgie, Wirbelsäulenzentrum, Universitätsklinik Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland

    C. Josten, C. Schmidt & U. Spiegl

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  1. C. Josten
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  2. C. Schmidt
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  3. U. Spiegl
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Correspondence to C. Josten.

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Josten, C., Schmidt, C. & Spiegl, U. Osteoporotische Wirbelkörperfrakturen der thorakolumbalen Wirbelsäule. Chirurg 83, 866–874 (2012). https://doi.org/10.1007/s00104-012-2338-2

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