Stellenwert der Zementaugmentation in der Tumorchirurgie der Wirbelsäule

Zusammenfassung

Die Wirbelsäule ist nach Leber und Lunge einer der wichtigsten Manifestationsorte für metastasierende Tumor-Erkrankungen. Metastasen der Wirbelsäule können zu Schmerzen, neurologischen Ausfällen und eingeschränkter Lebensqualität führen. Die Augmentation der befallenen Wirbelkörper mit Knochenzement hat sich als wirksame Behandlungsoption zur Schmerzbehandlung, Stabilisierung und Verbesserung der funktionellen Ergebnisse bei Patienten erwiesen. Weitere Anwendungen von Knochenzement in der Tumorchirurgie der Wirbelsäule sind die Augmentation von Pedikelschrauben und der Wirbelkörperersatz, selten auch bei der operativen Behandlung von Primärtumoren.

Ziel dieser Übersichtsarbeit ist es, einen umfassenden Überblick über die aktuelle Evidenz zur Verwendung von Knochenzement in der Tumorchirurgie der Wirbelsäule zu geben, einschließlich Indikationen, Techniken, Ergebnissen und potenziellen Komplikationen.

Abstract

The spine is one of the most frequent sites of manifestation for metastatic tumor disease. Vertebral metastases can lead to pain, neurological deficits and reduced quality of life. Augmentation of affected vertebral bodies with bone cement has been shown to be an effective treatment option for pain management, stabilization and improved functional outcomes in patients. Other applications of bone cement in spine tumor surgery include pedicle screw augmentation and vertebral body replacement, and rarely in the surgical treatment of primary tumors.

The aim of this review is to provide a comprehensive overview of the current evidence on the use of bone cement in spine tumor surgery, including indications, techniques, outcomes, and potential complications.

Schlüsselwörter

Tumor - Metastase - Wirbelsäule - Vertebroplastie - Kyphoplastie - Knochenzement

Keywords

tumor - metastastic disease - spine - vertebroplasty - kyphoplasty - bone cement

Publication History

Article published online:
24 October 2023

• Literatur

• 1 Galliker G, Scherer DE, Trippolini MA. et al. Low Back Pain in the Emergency Department: Prevalence of Serious Spinal Pathologies and Diagnostic Accuracy of Red Flags. Am J Med 2020; 133: 60-72.e14
• 2 Wong DA, Fornasier VL, MacNab I. Spinal metastases: the obvious, the occult, and the impostors. Spine 1990; 15: 1-4
• 3 Health Quality Ontario. Vertebral Augmentation Involving Vertebroplasty or Kyphoplasty for Cancer-Related Vertebral Compression Fractures: A Systematic Review. Ont Health Technol Assess Ser 2016; 16: 1-202
• 4 Bludau F, Winter L, Welzel G. et al. Long-term outcome after combined kyphoplasty and intraoperative radiotherapy (Kypho-IORT) for vertebral tumors. Radiat Oncol 2020; 15: 263
• 5 Werner CML, Osterhoff G, Schlickeiser J. et al. Vertebral body stenting versus kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a randomized trial. J Bone Joint Surg Am 2013; 95: 577-584
• 6 Fras C, Kravetz P, Mody DR. et al. Substance P-containing nerves within the human vertebral body. an immunohistochemical study of the basivertebral nerve. Spine J 2003; 3: 63-67
• 7 Ohtori S, Inoue G, Koshi T. et al. Characteristics of sensory dorsal root ganglia neurons innervating the lumbar vertebral body in rats. J Pain 2007; 8: 483-488
• 8 Fisher CG, DiPaola CP, Ryken TC. et al. A novel classification system for spinal instability in neoplastic disease: an evidence-based approach and expert consensus from the Spine Oncology Study Group. Spine 2010; 35: E1221-1229
• 9 Anselmetti GC, Marcia S, Saba L. et al. Percutaneous vertebroplasty: multi-centric results from EVEREST experience in large cohort of patients. Eur J Radiol 2012; 81: 4083-4086
• 10 Berenson J, Pflugmacher R, Jarzem P. et al. Balloon kyphoplasty versus non-surgical fracture management for treatment of painful vertebral body compression fractures in patients with cancer: a multicentre, randomised controlled trial. Lancet Oncol 2011; 12: 225-235
• 11 Schroeder JE, Ecker E, Skelly AC. et al. Cement augmentation in spinal tumors: a systematic review comparing vertebroplasty and kyphoplasty. Evid Based Spine Care J 2011; 2: 35-43
• 12 Yang Z, Yang Y, Zhang Y. et al. Minimal access versus open spinal surgery in treating painful spine metastasis: a systematic review. World J Surg Oncol 2015; 13: 68
• 13 Bae JW, Gwak H-S, Kim S. et al. Percutaneous vertebroplasty for patients with metastatic compression fractures of the thoracolumbar spine: clinical and radiological factors affecting functional outcomes. Spine J 2016; 16: 355-364
• 14 Tarawneh AM, Sabou S, AlKalbani S. et al. Clinical outcomes of sacroplasty for metastatic sacral tumours: a systematic review and meta-analysis. Eur Spine J 2020; 29: 3116-3122
• 15 Guo W-H, Meng M-B, You X. et al. CT-guided percutaneous vertebroplasty of the upper cervical spine via a translateral approach. Pain Physician 2012; 15: E733-741
• 16 Balestrino A, Boriani S, Cecchinato R. et al. Vertebroplasty shows no antitumoral effect on vertebral metastasis: a case-based study on anatomopathological examinations. Eur Spine J 2020; 29: 3157-3162
• 17 Mohme M, Riethdorf S, Dreimann M. et al. Circulating Tumour Cell Release after Cement Augmentation of Vertebral Metastases. Sci Rep 2017; 7: 7196
• 18 Murali N, Turmezei T, Bhatti S. et al. What is the effectiveness of radiofrequency ablation in the management of patients with spinal metastases? A systematic review and meta-analysis. J Orthop Surg Res 2021; 16: 659
• 19 Altaf F, Weber M, Dea N. et al. Evidence-Based Review and Survey of Expert Opinion of Reconstruction of Metastatic Spine Tumors. Spine 2016; 41: S254-S261
• 20 Jordan Y, Buchowski JM, Mokkarala M. et al. Outcomes and cost-minimization analysis of cement spacers versus expandable cages for posterior-only reconstruction of metastatic spine corpectomies. Ann Transl Med 2019; 7: 212
• 21 Sundaresan N, Galicich JH, Lane JM. et al. Treatment of neoplastic epidural cord compression by vertebral body resection and stabilization. J Neurosurg 1985; 63: 676-684
• 22 Hansebout RR, Blomquist GA Acrylic spinal fusion. A 20-year clinical series and technical note. J Neurosurg 1980; 53: 606-612
• 23 Eleraky M, Papanastassiou I, Tran ND. et al. Comparison of polymethylmethacrylate versus expandable cage in anterior vertebral column reconstruction after posterior extracavitary corpectomy in lumbar and thoraco-lumbar metastatic spine tumors. Eur Spine J 2011; 20: 1363-1370
• 24 Polster J, Wuisman P, Härle A. et al. Die ventrale Stabilisierung von primären Tumoren und Metastasen der Wirbelsäule mit dem Wirbelkörperimplantat und Palacos. Z Orthop Ihre Grenzgeb 1989; 127: 414-417
• 25 Spiegl UJ, Weidling M, Nitsch V. et al. Restricted cement augmentation in unstable geriatric midthoracic fractures treated by long-segmental posterior stabilization leads to a comparable construct stability. Sci Rep 2021; 11: 23816
• 26 Orenday-Barraza JM, Cavagnaro MJ, Avila MJ. et al. 10-Year Trends in the Surgical Management of Patients with Spinal Metastases: A Scoping Review. World Neurosurg 2022; 157: 170-186.e3
• 27 Ehresman J, Pennington Z, Elsamadicy AA. et al. Fenestrated pedicle screws for thoracolumbar instrumentation in patients with poor bone quality: Case series and systematic review of the literature. Clin Neurol Neurosurg 2021; 206: 106675