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Neurochirurgie Scan 2016; 04(04): 303-328
DOI: 10.1055/s-0042-109629
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Spinale Neurochirurgie
© Georg Thieme Verlag KG Stuttgart · New York

Osteoporotische Wirbelkörperfrakturen

Yu-Mi Ryang
,
Haiko Pape
,
Bernhard Meyer
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Publikationsverlauf

Publikationsdatum:
16. November 2016 (online)

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Zusammenfassung

Angesichts der Tatsache, dass es in Deutschland geschätzt zwischen 5 und 7 Millionen an Osteoporose erkrankter Menschen gibt, aber nur ein geringer Teil diagnostiziert und adäquat therapiert wird, besteht eine große Notwendigkeit in der Etablierung von Leitlinien und Standards, sowohl für Diagnostik und Identifizierung von Risikofaktoren als auch in der Therapie und Prophylaxe dieser „Volkskrankheit“. Durch die steigende Lebenserwartung werden die Zahl der Erkrankten und die damit verbundenen Kosten in den nächsten Jahren noch erheblich zunehmen.

Dieser Beitrag stellt zunächst Grundlagen der Erkrankung wie Epidemiologie, Definition und Risikofaktoren dar, weiter werden die etablierten Standards zu Prophylaxe, Diagnostik und konservativen Therapiemaßnahmen beschrieben, ehe detailliert auf die operativen Optionen bei osteoporotischen Wirbelkörperfrakturen eingegangen wird.

Kernaussagen

  • Die Diagnose Osteoporose wird heute immer häufiger gestellt. Dennoch ist die Rate mit 2/3 unerkannter osteoporotischer Kompressionsfrakturen der Wirbelsäule immer noch sehr hoch.

  • Trotz alledem wurden nicht nur in der konservativen, sondern auch in der operativen Behandlung in den letzten 10 Jahren einige Fortschritte erzielt. So werden immer häufiger minimalinvasive vertebrale Augmentationsverfahren zur operativen Behandlung symptomatischer osteoporotischer Kompressionsfrakturen eingesetzt. Bisherige Studien konnten zeigen, dass diese Verfahren sicher und effizient sind. Dennoch fehlen noch Ergebnisse großer Langzeitstudien, die zeigen, welche Patienten bei diesem sehr heterogenen Patientenkollektiv am ehesten von konservativen Therapiemaßnahmen, einer Kyphoplastie oder Vertebroplastie profitieren. Diese Unsicherheiten spiegeln sich daher auch in den sich zum Teil widersprechenden Leitlininien und Empfehlungen unterschiedlicher Gesellschaften und Gesundheitsorganisationen wider.

  • Die große Mehrheit der Patienten profitiert hinreichend von konservativen Behandlungsregimes. Nur ein kleiner Teil der Patienten leidet an konservativ therapierefraktären Beschwerden. Moderne klinische und bildgebende Verfahren wie das STIR-MRT können helfen, diese Patienten zu identifizieren und einer vertebralen Augmentationsprozedur zuzuführen.

  • Welches der beiden Verfahren (Vertebroplastie oder Kyphoplastie) überlegen ist, kann noch nicht mit letzter Sicherheit gesagt werden, auch in Bezug auf eine Reduktion des Mortalitätsrisikos. Sicher scheint jedoch, dass selektierte Patienten im Hinblick auf eine schnellere und effizientere Schmerzreduktion, Mobilisation und Wiedererlangung der Lebensqualität von vertebralen Augmentationsprozeduren profitieren.

  • Nur in seltenen Fällen mit Instabilität und/oder neurologischen Defiziten sind stabilisierende Operationen, ggf. auch mit Osteotomien, zur Kyphosekorrektur notwendig.

 

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