Download PDF
OP-Journal
DOI: 10.1055/a-2311-6246
Fachwissen

Verletzungen der thorakolumbalen Wirbelsäule beim geriatrischen Patienten: Diagnostik und Therapie

Thoracolumbar Spine Injury of the Elderly: Diagnostics and Therapy
Alexander Wengert
,
Philipp Schleicher
,
Andreas Pingel
,
Jonathan Neuhoff
,
Frank Kandziora
› Further Information
Also available at
    Permissions and Reprints

Osteoporotische Frakturen der Brust- und Lendenwirbelsäule spielen angesichts des demografischen Wandels und der zunehmenden Überalterung der Bevölkerung eine größer werdende Rolle. Komorbiditäten, Polypharmazie und Gebrechlichkeit machen geriatrische Patienten zu einer herausfordernden Klientel. Die korrekte Indikationsstellung zur konservativen oder operativen Behandlung entscheidet maßgeblich über das therapeutische Outcome.

Schlüsselwörter

osteoporotische Fraktur - Sinterungsfraktur - Geriatrie - Brustwirbelsäule - Lendenwirbelsäule

Keywords

osteoporotic fracture - sintering fracture - geriatrics - thoracic spine - lumbar spine


Publication History

Article published online:
08 October 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Dachverband Osteologie e. V. (DVO). Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und bei Männern ab dem 50. Lebensjahr. Leitlinie des Dachverbands der Deutschsprachigen Wissenschaftlichen Osteologischen Gesellschaften e. V. Langfassung V 2.1. AWMF-Registernummer: 183/001. 2023 Accessed September 06, 2024 at: https://register.awmf.org/assets/guidelines/183–001l_S3_Prophylaxe-Diagnostik-Therapie-der-Osteoporose_2023–11.pdf
    PubMedSearch in Google Scholar
  • 2 Scheidt-Nave C, Banzer D, Abendroth K. Schlussbericht multizentrische Studie zu Verteilung, Determination und prädiktivem Wert der Knochendichte in der deutschen Bevölkerung. Förderprojekt des Bundesministeriums für Forschung und Technologie. Förderkennzeichen 01KM 9304/0. 1997
    Search in Google Scholar
  • 3 Borgström F, Karlsson L, Ortsäter G. et al. International Osteoporosis Foundation Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos 2020; 15: 59
    CrossrefPubMedSearch in Google Scholar
  • 4 Freitas SS, Barrett-Connor E, Ensrud KE. et al. Rate and circumstances of clinical vertebral fractures in older men. Osteoporos Int 2008; 19: 615-623
    CrossrefPubMedSearch in Google Scholar
  • 5 Ballane G, Cauley JA, Luckey MM. et al. Worldwide prevalence and incidence of osteoporotic vertebral fractures. Osteoporos Int 2017; 28: 1531-1542
    CrossrefPubMedSearch in Google Scholar
  • 6 Schnake KJ, Blattert TR, Hahn P. et al. Classification of Osteoporotic Thoracolumbar Spine Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8(2 Suppl.): 46S-49S
    CrossrefPubMedSearch in Google Scholar
  • 7 Schönrogge M, Lahodski V, Otto R. et al. Inter- and intraobserver reliabilities and critical analysis of the osteoporotic fracture classification of osteoporotic vertebral body fractures. Eur Spine J 2022; 31: 2431-2438
    CrossrefPubMedSearch in Google Scholar
  • 8 Weaver DJ, Malik AT, Jain N. et al. The Modified 5-Item Frailty Index: A Concise and Useful Tool for Assessing the Impact of Frailty on Postoperative Morbidity Following Elective Posterior Lumbar Fusions. World Neurosurg 2019; 124: e626-e632
    CrossrefPubMedSearch in Google Scholar
  • 9 Scheyerer MJ, Ullrich B, Osterhoff G. et al. „Hounsfield units“ als Maß für die Knochendichte – Anwendungsmöglichkeiten in der Wirbelsäulenchirurgie. Unfallchirurg 2019; 122: 654-661
    CrossrefPubMedSearch in Google Scholar
  • 10 Lin W, He C, Xie F. et al. Quantitative CT screening improved lumbar BMD evaluation in older patients compared to dual-energy X-ray absorptiometry. BMC Geriatr 2023; 23: 231
    CrossrefPubMedSearch in Google Scholar
  • 11 Li N, Li X, Xu L. et al. Comparison of QCT and DXA: Osteoporosis Detection Rates in Postmenopausal Women. Int J Endocrinol 2013; 2013: 1-5
    CrossrefPubMedSearch in Google Scholar
  • 12 Blattert TR, Schnake KJ, Gonschorek O. et al. Nonsurgical and Surgical Management of Osteoporotic Vertebral Body Fractures: Recommendations of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU). Global Spine J 2018; 8(2 Suppl.): 50S-55S
    CrossrefPubMedSearch in Google Scholar
  • 13 Schnake KJ, Bula P, Spiegl UJ. et al. Thorakolumbale Wirbelsäulenfrakturen beim alten Menschen: Klassifikation und Therapie. Unfallchirurg 2017; 120: 1071-1085
    CrossrefPubMedSearch in Google Scholar
  • 14 Yildiz U, Schleicher P, Castein J. et al. Konservative Behandlung von Wirbelfrakturen in BWS und LWS – was geht wie?. Wirbelsäule 2019; 03: 313-335
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Carlson C. Effectiveness of the World Health Organization Cancer Pain Relief Guidelines: an Integrative Review. J Pain Res 2016; 9: 515-534
    CrossrefPubMedSearch in Google Scholar
  • 16 Kim GH, Cho TG. A Comparative Study on the Treatment of Osteoporotic Vertebral Compression Fractures With Early Ambulation and at Least 1 Week of Absolute Bed Rest. Korean J Neurotrauma 2022; 18: 56
    CrossrefPubMedSearch in Google Scholar
  • 17 Petitt JC, Desai A, Kashkoush A. et al. Failure of Conservatively Managed Traumatic Vertebral Compression Fractures: A Systematic Review. World Neurosurg 2022; 165: 81-88
    CrossrefPubMedSearch in Google Scholar
  • 18 Guo JB, Zhu Y, Chen BL. et al. Surgical Versus Non-Surgical Treatment for Vertebral Compression Fracture with Osteopenia: A Systematic Review and Meta-Analysis. PloS One 2015; 10: e0127145
    CrossrefPubMedSearch in Google Scholar
  • 19 Hofler RC, Jones GA. Bracing for Acute and Subacute Osteoporotic Compression Fractures: A Systematic Review of the Literature. World Neurosurg 2020; 141: e453-e460
    CrossrefPubMedSearch in Google Scholar
  • 20 Wang H, Sribastav SS, Ye F. et al. Comparison of Percutaneous Vertebroplasty and Balloon Kyphoplasty for the Treatment of Single Level Vertebral Compression Fractures: A Meta-analysis of the Literature. Pain Physician 2015; 18: 209-222
    PubMedSearch in Google Scholar
  • 21 Hulme PA, Krebs J, Ferguson SJ. et al. Vertebroplasty and Kyphoplasty: A Systematic Review of 69 Clinical Studies. Spine (Phila Pa 1976) 2006; 31: 1983-2001
    CrossrefPubMedSearch in Google Scholar
  • 22 Patel N, Jacobs D, John J. et al. Balloon Kyphoplasty vs Vertebroplasty: A Systematic Review of Height Restoration in Osteoporotic Vertebral Compression Fractures. J Pain Res 2022; 15: 1233-1245
    CrossrefPubMedSearch in Google Scholar
  • 23 Xing D, Ma JX, Ma XL. et al. A meta-analysis of balloon kyphoplasty compared to percutaneous vertebroplasty for treating osteoporotic vertebral compression fractures. J Clin Neurosci 2013; 20: 795-803
    CrossrefPubMedSearch in Google Scholar
  • 24 Wang B, Zhao CP, Song LX. et al. Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: a meta-analysis and systematic review. J Orthop Surg 2018; 13: 264
    CrossrefPubMedSearch in Google Scholar
  • 25 Wiltse LL, Bateman JG, Hutchinson RH. et al. The paraspinal sacrospinalis-splitting approach to the lumbar spine. J Bone Joint Surg Am 1968; 50: 919-926
    CrossrefPubMedSearch in Google Scholar
  • 26 Wiedenhöfer B, Carstens C, Pfeil J. et al. Osteotomien der Wirbelsäule – Schritt für Schritt. Orthopädie und Unfallchirurgie up2date 2022; 17: 331-335
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Hu X, Ma W, Chen J. et al. Posterior short segment fixation including the fractured vertebra combined with kyphoplasty for unstable thoracolumbar osteoporotic burst fracture. BMC Musculoskelet Disord 2020; 21: 566
    CrossrefPubMedSearch in Google Scholar
  • 28 Lai O, Zhang X, Hu Y. et al. Long-segment fixation VS short-segment fixation combined with kyphoplasty for osteoporotic thoracolumbar burst fracture. BMC Musculoskelet Disord 2022; 23: 160
    CrossrefPubMedSearch in Google Scholar
  • 29 Ishikawa Y, Watanabe K, Katsumi K. et al. Short- versus long-segment posterior spinal fusion with vertebroplasty for osteoporotic vertebral collapse with neurological impairment in thoracolumbar spine: a multicenter study. BMC Musculoskelet Disord 2020; 21: 513
    CrossrefPubMedSearch in Google Scholar
  • 30 Joshi D, Kakadiya G, Attar U. Time to revisit contraindications of vertebroplasty- A retrospective study of osteoporotic burst fracture operated with vertebroplasty and short segment fixation. N Am Spine Soc J 2022; 10: 100111
    CrossrefPubMedSearch in Google Scholar
  • 31 Spiegl UJA, Schenk P, Schnake KJ. et al. Treatment and Outcome of Osteoporotic Thoracolumbar Vertebral Body Fractures With Deformation of Both Endplates With or Without Posterior Wall Involvement (OF 4): Short-Term Results from the Prospective EOFTT Multicenter Study. Global Spine J 2023; 13(1 Suppl.): 36S-43S
    CrossrefPubMedSearch in Google Scholar
  • 32 Girardo M, Massè A, Risitano S. et al. Long versus Short Segment Instrumentation in Osteoporotic Thoracolumbar Vertebral Fracture. Asian Spine J 2021; 15: 424-430
    CrossrefPubMedSearch in Google Scholar
  • 33 Wu Y, Chen CH, Tsuang FY. et al. The stability of long-segment and short-segment fixation for treating severe burst fractures at the thoracolumbar junction in osteoporotic bone: A finite element analysis. PLoS One 2019; 14: e0211676
    CrossrefPubMedSearch in Google Scholar
  • 34 Li J, Xu L, Liu Y. et al. Open Surgical Treatments of Osteoporotic Vertebral Compression Fractures. Orthop Surg 2023; 15: 2743-2748
    CrossrefPubMedSearch in Google Scholar
  • 35 Josten C, Schmidt C, Spiegl U. Osteoporotische Wirbelkörperfrakturen der thorakolumbalen Wirbelsäule: Diagnostik und Behandlungsstrategien. Chirurg 2012; 83: 866-874
    CrossrefPubMedSearch in Google Scholar
  • 36 Schnake KJ, Blattert TR, Liljenqvist U. Zementaugmentation von Pedikelschrauben: Vorteile und Nachteile. Orthopäde 2016; 45: 755-759
    CrossrefPubMedSearch in Google Scholar
  • 37 Kolb JP, Weiser L, Kueny RA. et al. Zementaugmentation an der Wirbelsäule: Was ist biomechanisch zu beachten?. Orthopäde 2015; 44: 672-680
    CrossrefPubMedSearch in Google Scholar
  • 38 Marcia S, Muto M, Hirsch JA. et al. What is the role of vertebral augmentation for osteoporotic fractures? A review of the recent literature. Neuroradiology 2018; 60: 777-783
    CrossrefPubMedSearch in Google Scholar
  • 39 Zhu RS, Kan SL, Ning GZ. et al. Which is the best treatment of osteoporotic vertebral compression fractures: balloon kyphoplasty, percutaneous vertebroplasty, or non-surgical treatment? A Bayesian network meta-analysis. Osteoporos Int 2019; 30: 287-298
    CrossrefPubMedSearch in Google Scholar
  • 40 Yuan WH, Hsu HC, Lai KL. Vertebroplasty and balloon kyphoplasty versus conservative treatment for osteoporotic vertebral compression fractures: A meta-analysis. Medicine (Baltimore) 2016; 95: e4491
    CrossrefPubMedSearch in Google Scholar
  • 41 Wardlaw D, Cummings SR, Van Meirhaeghe J. et al. Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 2009; 373: 1016-1024
    CrossrefPubMedSearch in Google Scholar
  • 42 Edidin AA, Ong KL, Lau E. et al. Morbidity and Mortality After Vertebral Fractures: Comparison of Vertebral Augmentation and Nonoperative Management in the Medicare Population. Spine (Phila Pa 1976) 2015; 40: 1228-1241
    CrossrefPubMedSearch in Google Scholar
  • 43 Buchbinder R, Osborne RH, Ebeling PR. et al. A Randomized Trial of Vertebroplasty for Painful Osteoporotic Vertebral Fractures. N Engl J Med 2009; 361: 557-568
    CrossrefPubMedSearch in Google Scholar
  • 44 Kallmes DF, Comstock BA, Heagerty PJ. et al. A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures. N Engl J Med 2009; 361: 569-579
    CrossrefPubMedSearch in Google Scholar
  • 45 Zhang H, Xu C, Zhang T. et al. Does Percutaneous Vertebroplasty or Balloon Kyphoplasty for Osteoporotic Vertebral Compression Fractures Increase the Incidence of New Vertebral Fractures? A Meta-Analysis. Pain Physician 2017; 20: E13-E28
    CrossrefPubMedSearch in Google Scholar
  • 46 Wang F, Wang LF, Miao DC. et al. Which one is more effective for the treatment of very severe osteoporotic vertebral compression fractures: PVP or PKP?. J Pain Res 2018; 11: 2625-2631
    CrossrefPubMedSearch in Google Scholar