Skip to main content
SpringerLink
Log in

Kyphoplastie und Vertebroplastie

Indikationen, Techniken, Komplikationen und Ergebnisse

Kyphoplasty and vertebroplasty

Indications, techniques, complications and results

  • CME Weiterbildung · Zertifizierte Fortbildung
  • Published:
Der Unfallchirurg Aims and scope Submit manuscript

Zusammenfassung

Die Indikationen, technischen Prinzipien und Ergebnisse der Vertebroplastie und Kyphoplastie werden dargestellt. Ein Schwerpunkt ist die genaue Darstellung der Komplikationen beider Verfahren. Durch 2 kürzlich im New England Journal of Medicine publizierte klinische Studien ist der Nutzen der Vertebroplastie grundsätzlich in Frage gestellt worden. Die vorliegende Arbeit arbeitet die derzeit geltenden Indikationen heraus. Die zurzeit widersprüchliche Studienlage wird beschrieben, auffällig ist der Mangel an randomisierten klinischen Studien. Eine abschließende Bewertung der beiden Techniken ist daher derzeit nicht möglich. Neuere Verfahren wie die Stentkyphoplastie oder die Lordoplastie werden knapp beschrieben. Eine Bewertung dieser Verfahren ist zum gegenwärtigen Zeitpunkt noch nicht möglich. Eine ähnliche Situation ist für die Anwendung von resorbierbaren Knochenzementen gegeben.

Abstract

The indications, technical principals, and results after vertebroplasty and kyphoplasty are presented in detail. We focus on the complications of both procedures. The benefit of vertebroplasty has been fundamentally questioned by two papers which have recently been published in the New England Journal of Medicine. Our paper discusses the present knowledge and policy about indication. The contradictory results from different studies are presented. In general, there is a lack of randomized clinical trials. Therefore, a final judgement of these two techniques is not possible. New procedures like stent-kyphoplasty or lordoplasty are briefly described. However, at present an assessment of these new techniques is impossible. A similar situation is give for the application of resorbable bone cements.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. Baroud G, Crookshank M, Bohner M (2006) High-viscosity cement significantly enhances uniformity of cement filling in vertebroplasty: an experimental model and study on cement leakage. Spine 31:2562–2568

    Article  PubMed  Google Scholar 

  2. Baroud G, Nemes J, Heini P, Steffen T (2003) Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J 12:421–426

    Article  PubMed  CAS  Google Scholar 

  3. Belkoff SM, Molloy S (2003) Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty. Spine 28:1555–1559

    PubMed  Google Scholar 

  4. Boszczyk B (2010) Volume matters: a review of procedural details of two randomised controlled vertebroplasty trials of 2009. Eur Spine J 19:1837–1840

    Article  PubMed  Google Scholar 

  5. Buchbinder R, Osborne RH, Ebeling PR et al (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361:557–568

    Article  PubMed  CAS  Google Scholar 

  6. Eck JC, Nachtigall D, Humphreys SC, Hodges SD (2008) Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. Spine J 8:488–497

    Article  PubMed  Google Scholar 

  7. Evans AJ, Jensen ME, Kip KE et al (2003) Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 226:366–372

    Article  PubMed  Google Scholar 

  8. Furderer S, Anders M, Schwindling B et al (2002) Vertebral body stenting. A method for repositioning and augmenting vertebral compression fractures. Orthopäde 31:356–361

    Article  PubMed  CAS  Google Scholar 

  9. Galibert P, Deramond H, Rosat P, Le Gars D (1987) Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty. Neurochirurgie 33:166–168

    PubMed  CAS  Google Scholar 

  10. Georgy BA (2010) Clinical experience with high-viscosity cements for percutaneous vertebral body augmentation: occurrence, degree, and location of cement leakage compared with kyphoplasty. AJNR Am J Neuroradiol 31:504–508

    Article  PubMed  CAS  Google Scholar 

  11. Grohs JG, Matzner M, Trieb K, Krepler P (2005) Minimal invasive stabilization of osteoporotic vertebral fractures: a prospective nonrandomized comparison of vertebroplasty and balloon kyphoplasty. J Spinal Disord Tech 18:238–242

    PubMed  Google Scholar 

  12. Heini PF, Orler R (2004) Kyphoplasty for treatment of osteoporotic vertebral fractures. Eur Spine J 13:184–192

    Article  PubMed  Google Scholar 

  13. Heini PF, Orler R (2004) Vertebroplasty in severe osteoporosis. Technique and experience with multi-segment injection. Orthopäde 33:22–30

    Article  PubMed  CAS  Google Scholar 

  14. Heini PF, Walchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 9:445–450

    Article  PubMed  CAS  Google Scholar 

  15. Hide IG, Gangi A (2004) Percutaneous vertebroplasty: history, technique and current perspectives. Clin Radiol 59:461–467

    Article  PubMed  CAS  Google Scholar 

  16. Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and kyphoplasty: a systematic review of 69 clinical studies. Spine 31:1983–2001

    Article  PubMed  Google Scholar 

  17. Kallmes DF, Comstock BA, Heagerty PJ et al (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361:569–579

    Article  PubMed  CAS  Google Scholar 

  18. Katonis P, Pasku D, Alpantaki K et al (2009) Treatment of pathologic spinal fractures with combined radiofrequency ablation and balloon kyphoplasty. World J Surg Oncol 7:90

    Article  PubMed  Google Scholar 

  19. Lieberman IH, Dudeney S, Reinhardt MK, Bell G (2001) Initial outcome and efficacy of „kyphoplasty“ in the treatment of painful osteoporotic vertebral compression fractures. Spine 26:1631–1638

    Article  PubMed  CAS  Google Scholar 

  20. Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26:1547–1554

    Article  PubMed  CAS  Google Scholar 

  21. Lindsay R, Silverman SL, Cooper C et al (2001) Risk of new vertebral fracture in the year following a fracture. JAMA 285:320–323

    Article  PubMed  CAS  Google Scholar 

  22. Lopez LM, Grimes DA, Schulz KF, Curtis KM (2009) Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev:CD006033

    Google Scholar 

  23. Luo J, Daines L, Charalambous A et al (2009) Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine 34:2865–2873

    Article  PubMed  Google Scholar 

  24. Marco RA, Meyer BC, Kushwaha VP (2010) Thoracolumbar burst fractures treated with posterior decompression and pedicle screw instrumentation supplemented with balloon-assisted vertebroplasty and calcium phosphate reconstruction. Surgical technique. J Bone Joint Surg Am 92 (Suppl 1):67–76

    Article  PubMed  Google Scholar 

  25. Maynard AS, Jensen ME, Schweickert PA et al (2000) Value of bone scan imaging in predicting pain relief from percutaneous vertebroplasty in osteoporotic vertebral fractures. AJNR Am J Neuroradiol 21:1807–1812

    PubMed  CAS  Google Scholar 

  26. McKiernan F, Jensen R, Faciszewski T (2003) The dynamic mobility of vertebral compression fractures. J Bone Miner Res 18:24–29

    Article  PubMed  Google Scholar 

  27. Molloy S, Mathis JM, Belkoff SM (2003) The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine 28:1549–1554

    PubMed  Google Scholar 

  28. Orler R, Frauchiger LH, Lange U, Heini PF (2006) Lordoplasty: report on early results with a new technique for the treatment of vertebral compression fractures to restore the lordosis. Eur Spine J 15:1769–1775

    Article  PubMed  Google Scholar 

  29. Patel AA, Vaccaro AR, Martyak GG et al (2007) Neurologic deficit following percutaneous vertebral stabilization. Spine 32:1728–1734

    Article  PubMed  Google Scholar 

  30. Pluijm SM, Tromp AM, Smit JH et al (2000) Consequences of vertebral deformities in older men and women. J Bone Miner Res 15:1564–1572

    Article  PubMed  CAS  Google Scholar 

  31. Rauschmann M, Vogl T, Verheyden A et al (2010) Bioceramic vertebral augmentation with a calcium sulphate/hydroxyapatite composite (Cerament SpineSupport): in vertebral compression fractures due to osteoporosis. Eur Spine J 19:887–892

    Article  PubMed  Google Scholar 

  32. Riggs BL, Melton LJ, III (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17 (Suppl):505S–511S

    Article  PubMed  CAS  Google Scholar 

  33. Shapiro S, Abel T, Purvines S (2003) Surgical removal of epidural and intradural polymethylmethacrylate extravasation complicating percutaneous vertebroplasty for an osteoporotic lumbar compression fracture. Case report. J Neurosurg 98 (Suppl):90–92

    PubMed  Google Scholar 

  34. Spivak JM, Johnson MG (2005) Percutaneous treatment of vertebral body pathology. J Am Acad Orthop Surg 13:6–17

    PubMed  Google Scholar 

  35. Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine 31:2747–2755

    Article  PubMed  Google Scholar 

  36. Teng MM, Cheng H, Ho DM, Chang CY (2006) Intraspinal leakage of bone cement after vertebroplasty: a report of 3 cases. AJNR Am J Neuroradiol 27:224–229

    PubMed  CAS  Google Scholar 

  37. Tohmeh AG, Mathis JM, Fenton DC et al (1999) Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine 24:1772–1776

    Article  PubMed  CAS  Google Scholar 

  38. Wardlaw D, Cummings SR, Van Meirhaeghe J et al (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373:1016–1024

    Article  PubMed  Google Scholar 

  39. Wuisman PI, van Dijk M, Staal H, van Royen BJ (2000) Augmentation of (pedicle) screws with calcium apatite cement in patients with severe progressive osteoporotic spinal deformities: an innovative technique. Eur Spine J 9:528–533

    Article  PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, Schwerpunkt Unfallchirurgie, Universitätsklinikum, Pauwelsstraße 30, 52074, Aachen, Deutschland

    B. Schmidt-Rohlfing, R. Pfeifer, P. Kobbe &  H.C. Pape

  2. Unfallchirurgische Klinik, Städtisches Klinikum, Braunschweig, Deutschland

    H. Reilmann

Authors
  1. B. Schmidt-Rohlfing
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Reilmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Pfeifer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Kobbe
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H.C. Pape
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H.C. Pape.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schmidt-Rohlfing, B., Reilmann, H., Pfeifer, R. et al. Kyphoplastie und Vertebroplastie. Unfallchirurg 114, 431–444 (2011). https://doi.org/10.1007/s00113-011-2013-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00113-011-2013-y

Schlüsselwörter

Keywords

Search

Navigation