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Vertebroplastik bei hochgradiger Osteoporose

Technik und Erfahrung mit plurisegmentalen Injektionen

Zusammenfassung

Bei schwerer Osteoporose ist der progressive Kollaps mehrerer Wirbelkörper mit konsekutivem Haltungsverlust ein ungelöstes Problem. Die medikamentöse Therapie greift zu langsam, um diesen Verlauf aufzuhalten. Die zunehmende Erfahrung mit der Vertebroplastik hat dazu geführt, bei hochgradiger Osteoporose die mehrsegmentale Zementierungen durchzuführen. Von 362 Patienten, die im Verlauf der letzten 5 Jahre mit perkutaner Zement Injektion behandelt wurden, sind bei 100 Patienten 5 oder mehr Höhen augmentiert worden (Range=7,3; maximal 14,0). Die operative Technik wurde dahingehend verfeinert, dass problemlos 6 Niveaus monolateral in Lokalanästhesie verstärkt werden können. Pro Eingriff sollte diese Anzahl nicht überschritten bzw. nicht mehr als 25–30 ml Zement appliziert werden.

Die Ergebnisse sind ermutigend. In 84% der Patienten konnte ein ausgeprägtes Schmerzsyndrom reduziert werden (von 7,6 nach 2,7 VAS). Noch eindrücklicher ist die subjektive Angabe der Patienten, die eine bessere Körperhaltung und mehr Kraft in ihrem Rücken beobachten und dadurch ihr Leben wieder aktiver gestalten können. Die radiologische Nachuntersuchung über 1 Jahr zeigt einen stationären Verlauf ohne weitere Sinterung der augmentierten Wirbel und einen erhaltenen Zwischenwirbelraum. Multisegmentale Vertebroplastik ist effizient und kann das weitere Zusammensintern und damit den Haltungsverlust verhindern. Aufgrund des Risikos der Fettembolie sollte die Augmentation auf 6 Höhen pro Eingriff beschränkt bleiben.

Abstract

In severe osteoporosis progressive collapse of multiple vertebrae is an unsolved problem. Medical treatment appears to be too slow to prevent the course. The evolving experience with vertebroplasty led us to treat these problems with more extensive cement injections. Of 362 patients who were treated with percutaneous cement injection over a 5-year period, 100 were injected at five and more levels (average 7.3, maximum 14). The surgical technique has been refined, allowing six levels to be injected monolaterally under local anesthesia. No more than six levels or 25–30 cc of cement should be injected per session.

The outcome of the procedure is favorable in 84% of patients with a significant pain decrease (from 7.6 to 2.7 VAS). More impressive is the subjective report of the patients about better posture and increased force in their back, allowing them to become more active again. The radiological follow-up for 1 year shows a stable situation without further sintering of the reinforced vertebrae and maintained disc space in between these vertebrae. Vertebroplasty on multiple levels is efficient and can prevent further collapse. Due the risk of fat embolism the injections should be limited to six levels per session.

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Correspondence to Dr. P. F. Heini.

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Heini, P.F., Orler, R. Vertebroplastik bei hochgradiger Osteoporose. Orthopäde 33, 22–30 (2004). https://doi.org/10.1007/s00132-003-0574-3

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Schlüsselwörter

  • Wirbelsäule
  • Osteoporose
  • Sinterungsfraktur
  • Haltungsverlust
  • Vertebroplastik

Keywords

  • Spine
  • Osteoporosis
  • PMMA
  • Posture
  • Vertebroplasty
  • Sagittal alignment