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Perkutane Vertebroplastie: Indikationen, Kontraindikationen und Technik

  • Interventionen an der Wirbelsäule
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Zusammenfassung

Zielsetzung

In den letzten Jahren gewinnt die perkutane Vertebroplastie (PV) weltweit zunehmend an Bedeutung. In diesem Beitrag werden die korrekte Indikationsstellung, die Vorbereitung der Patienten, geeignete Materialien sowie das technische Vorgehen bei dieser Behandlungsmethode dargestellt.

Technik

Die PV ist ein minimal-invasives Verfahren, bei dem—unter radiologischer Kontrolle—Knochenzement über eine Hohlnadel in einen Wirbelkörper injiziert wird und damit Schmerzen behandelt werden, die durch einen knöchernen Stabilitätsverlust der Wirbelkörper hervorgerufen werden.

Ergebnisse

Indikationen zur Durchführung der Vertebroplastie sind nichtradikuläre, konservativ nicht behandelbare Schmerzen, die durch Kompressionsfrakturen von Wirbelkörpern aufgrund einer Osteoporose, benignen (aggressiven Hämangiomen) oder malignen Tumoren (z. B. Myelomen, Metastasen) verursacht werden. Die Vertebroplastie ist kontraindiziert, wenn therapierefraktäre Blutgerinnungsstörungen vorliegen oder wenn die Beschwerdesymptomatik durch die Kompression der Nervenwurzel oder des Myelons verursacht wird.

Diskussion

Die PV ist ein sehr effektives Verfahren, welches ermöglicht, schnelle Beschwerdefreiheit nach malignen oder benignen Frakturen von Wirbelkörpern zu gewährleisten. Der Behandlungserfolg wird maßgeblich von der korrekten Indikationsstellung und Patientenauswahl, aber auch von der verwendeten Technik und nicht zuletzt von der Erfahrung des behandelnden Radiologen bestimmt.

Abstract

Purpose

Percutaneous vertebroplasty (pv) is a worldwide increasingly performed interventional therapeutic procedure. This article addresses indications, patient preparation, technical requirements and approach as well as possible complications of percutaneous vertebroplasty.

Technique

Percutaneous vertebroplasty is a technique consisting in an injection of bone cement into a vertebral body under imaging guidance. This procedure is performed to relief pain and support the mechanical stability in partially collapsed vertebral bodies.

Results

In the management of spinal compression fractures secondary to osteoporosis, myeloma, osteolytic metastases and aggressive hemangiomas, percutaneous vertebroplasty yields analgesic effect, and provides additional fortification in weakened segments of the vertebral column. Contraindications include major bleeding disorders, radicular pain and pain caused by compression of the myelon.

Discussion

Percutaneous vertebroplasty results in prompt pain relief and rapid rehabilitation. In experienced hands, using correct technique, pv is a safe and effective procedure for treating pain, caused either by osteoporotic or malignant vertebral compression fractures.

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Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Universität München-Großhadern

    R. T. Hoffmann, T. F. Jakobs, A. Wallnöfer, M. F. Reiser & T. K. Helmberger

  2. Institut für Klinische Radiologie, Klinikum der Universität München-Großhadern, Marchioninistr. 15, 81377 , München

    R. T. Hoffmann

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  1. R. T. Hoffmann
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  2. T. F. Jakobs
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Correspondence to R. T. Hoffmann.

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Hoffmann, R.T., Jakobs, T.F., Wallnöfer, A. et al. Perkutane Vertebroplastie: Indikationen, Kontraindikationen und Technik. Radiologe 43, 709–717 (2003). https://doi.org/10.1007/s00117-003-0947-y

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