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DOI: 10.1055/a-2167-1302
OF2 # mit sekundärer Sinterung – operative Therapie
OF2 # with Secondary Compression – Surgical Treatment
Zusammenfassung
Eine sekundäre Nachsinterung bei osteoporotischen Frakturen unter Mobilisation tritt häufig auf und führt nicht zwangsläufig zum Verlassen der konservativen Therapiestrategie. Niemals sollte eine Therapieentscheidung rein bildmorphologisch gestellt werden, jedoch liefert eine genaue Analyse der initialen computer- und kernspintomographischen Bilder häufig bereits einen Anhalt bezüglich des Risikos einer sekundären Nachsinterung bis hin zum vertebralen Kollaps. Diese Risikofaktoren müssen in die Therapieplanung einbezogen werden und können die Indikation zur operativen Therapie frühzeitig triggern. Hierbei stellt die Kyphoplastie die Methode der Wahl dar, sollte jedoch bei Osteonekrosezonen oder größeren Endplattendefekten zu Gunsten einer Hybridstabilisierung in den Hintergrund rücken. Invasive dorso-ventrale Versorgungen sind Einzelfällen, insbesondere bei eingetretenem vertebralem Kollaps, vorbehalten.
Abstract
Secondary sintering of osteoporotic vertebral fractures under mobilization occurs frequently and does not necessarily lead to abandon a conservative treatment strategy. A treatment plan should never be based purely on radiological imaging; however, a precise analysis of the initial computer tomographic and magnetic resonance images often already provides risk factors for secondary sintering up to vertebral collapse. These risk factors must be included in the treatment strategy and may trigger the indication for surgical treatment at an early stage. Kyphoplasty is the method of choice, but should be neglected in favour of hybrid stabilization in case of vertebral necrosis or larger endplate defects. Invasive circumferential treatment is reserved for individual cases, especially in cases of vertebral collapse.
Publication History
Article published online:
07 February 2024
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