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Osteoporosebedingte Wirbelkörperfrakturen

Kyphoplastie und Vertebroplastie vs. konservative Therapie

Vertebral fractures due to osteoporosis

Kyphoplasty and vertebroplasty vs conservative treatment

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Zusammenfassung

Wirbelkörperkompressionsfrakturen stellen eine der häufigsten Manifestationsformen der Osteoporose dar. Die konservative Therapie umfasst neben einer adäquaten Schmerztherapie v. a. die Sekundärprophylaxe zur Senkung des Risikos weiterer osteoporosebedingter Frakturen. Neben einer medikamentösen Osteoporosetherapie beinhaltet dies individuell auch Krankengymnastik und Orthesen. In vielen Fällen führen osteoporosebedingte Wirbelkörperkompressionsfrakturen jedoch zu anhaltenden Schmerzen und Einschränkungen in der Aktivität und Lebensqualität. In diesen Fällen können Kyphoplastie und Vertebroplastie effektive Behandlungsoptionen darstellen.

Bei der Vertebroplastie wird minimal-invasiv unter Durchleuchtungskontrolle eine innere Stabilisierung des Wirbelkörpers durch Auffüllen mit Knochenzement durchgeführt, welches meistens zu einer schnellen Schmerzreduktion führt. Bei der Kyphoplastie erfolgt zusätzlich eine Reposition des Wirbelkörpers mittels Ballonkatheter, um so zumindest teilweise das sagittale Profil der Wirbelsäule wiederherzustellen. Für beide Verfahren besteht eine umfangreiche klinische Erfahrung. Für die Kyphoplastie wurde in einer größeren kontrollierten randomisierten Studie eine signifikante Schmerzreduktion und Verbesserung der Lebensqualität nachgewiesen. Komplikationen sind selten, Zementaustritte aus dem Wirbelkörper können jedoch zu schwerwiegenden Komplikationen wie Lungenembolien und Nervenschäden führen.

Abstract

Vertebral compression fractures are among the most common forms of manifestations of osteoporosis. Conservative treatment comprises adequate analgesia, osteoporosis medication and individualized physiotherapy or braces. Nevertheless, vertebral compression fractures frequently lead to persisting pain and decrease daily activity and quality of life. In these cases, kyphoplasty and vertebroplasty can be efficient treatment options.

Vertebroplasty is a minimally invasive procedure, in which bone cement is filled into the vertebral body under fluoroscopic control. In most cases, this internal stabilization leads to a rapid reduction in pain. Kyphoplasty additionally aims to correct the kyphotic deformation of the broken vertebra via introducing and inflating a balloon catheter. There is broad clinical experience with both procedures. For kyphoplasty, randomized controlled trials showed significant improvements in pain and quality of life in patients undergoing kyphoplasty. However, cement leakages lead to rare but severe complications such as pulmonary embolism and nerve palsies.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Dr. Müller hat von der Fa. Medtronic Referentenhonorare erhalten. Trotz des möglichen Interessenkonflikts ist der Beitrag unabhängig und produktneutral.

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Authors and Affiliations

  1. Abteilung Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625, Hannover, Deutschland

    C.W. Müller, T. Gösling, A. Mameghani, R. Stier, M. Klein, T. Hüfner & C. Krettek

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  1. C.W. Müller
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  2. T. Gösling
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  3. A. Mameghani
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Correspondence to C.W. Müller.

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Müller, C., Gösling, T., Mameghani, A. et al. Osteoporosebedingte Wirbelkörperfrakturen. Orthopäde 39, 417–424 (2010). https://doi.org/10.1007/s00132-009-1576-6

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