Die osteoporotische Wirbelkörperfraktur

Durch eine alternde Bevölkerung wird das Problem der osteoporotischen Wirbelkörperfrakturen zunehmen. Diese Frakturen sind eine Konsequenz eines Knochenmasseverlustes und der Zerstörung der Knochenarchitektur. Das Hauptsymptom ist ein lokalisierter Rückenschmerz mit Funktionseinschränkungen. Eine schnelle und konsequente Therapie mit dem Ziel der Schmerzreduktion und Wiedererlangung der Mobilität sind bei diesen Frakturen unabdingbar. Die Zementaugmentation der Wirbelsäule stellt eine sinnvolle Therapieoption für schmerzhafte osteoporotische Wirbelkörperkompressionsfrakturen dar. Die Evidenz der vorliegenden Literatur zeigt eindeutig die Überlegenheit der Augmentation der Wirbelkörper, nach korrekter Indikationsstellung, gegenüber einer optimierten, konservativen Therapie. Die unterschiedlichen Verfahren wie die Vertebroplastie und die verschiedenen Formen der Kyphoplastie erbringen in der internationalen Literatur deutliche Vorteile in Bezug auf den klinischen Endpunkt Schmerzreduktion.

Seit einiger Zeit sind verschiedene gute Arbeiten erschienen, die zeigten, dass durch die Augmentation einer osteoporotischen Wirbelkörperfraktur das Hauptproblem der Patienten schnell und anhaltend signifikant verbessert werden kann. Bisher konnte die Aufrichtung der Wirbelsäule durch eine Kyphoplastie zwar oftmals statistisch signifikant nachgewiesen werden, aber es fehlt jeglicher Beweis dafür, dass dies auch mit einer klinischen Verbesserung einhergeht.

Bei gleichen klinischen Ergebnissen steigt die Relevanz von Nebenwirkungen und Komplikationen dieser chirurgischen Verfahren. Neben geringen schwerwiegenden Komplikationen ist vor allem die Rate an Zementaustritten und Lungenembolien mit Zement eine relevante Größe. Die Ballon-Kyphoplastie hat in diesem Zusammenhang auch in großen kontrollierten Studien eine deutlich geringere Rate an Zementaustritten erbracht als die Vertebroplastie in ähnlichen Studien. Der Einsatz von hoch viskösem Zement und der Option der kontrollierten Zementapplikation hat in ersten Studien diesbezüglich noch einmal Verbesserungen erbracht.

Due to demographic changes and an aging population, there will be an increasing number of osteoporotic compression fractures. These fractures are the result of bone loss and the deterioration of bone architecture. A consequent treatment with a focus on pain reduction and regaining function is mandatory.

Cement augmentation of the spine is a useful therapeutic option for painful osteoporotic vertebral compression fractures. The different procedures such as vertebroplasty and kyphoplasty provide distinct advantages in terms of the clinical outcomes pain reduction as described in the international literature. Several, recently published studies have shown that the augmentation of osteoporotic vertebral compression fractures result in a quick and long lasting improvement with regard to pain. So far, the hight reconstruction of the fractured vertebral body by a kyphoplasty has been shown by significant differences before and after the intervention, however it lacks of any evidence that this is associated with clinical improvement of the patients. Knowing that the different procedures bring the same clinical outcome results, the side effects and complications of the surgical interventions are becoming increasingly important. In the development of new techniques lowering serious complications, especially the rate of cement leaks and pulmonary cement embolism with cement is an important variable. Balloon kyphoplasty provided in large controlled studies a significantly lower rate of cement leakages compared to vertebroplasty in similar conducted studies. The use of high-viscosity cement, and the option of controlled cement application has again improved this in the first clinical studies performed.

Key words

Osteoporotic compression fractures - pain reduction - cement augmentation of the spine - vertebroplasty - kyphoplasty - cement leaks - pulmonary cement embolism

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