Perkutane Vertebroplastie und Kyphoplastie

Zusammenfassung

Die perkutane Vertebroplastie (PVP) ist ein minimalinvasives Verfahren, bei welchem unter radiologischer Kontrolle Knochenzement in einen Wirbelkörper eingebracht wird. Die Technik wurde ursprünglich zur Behandlung aggressiver Wirbelkörperhämangiome eingesetzt; inzwischen stellen osteoporotische Wirbelkörperfrakturen und andere schmerzhafte Wirbelkörperprozesse - vornehmlich Metastasen - die Hauptindikationen dar. Bei der mit der PVP verwandten Kyphoplastie (KP) werden expandierbare Ballons in den Wirbelkörper eingebracht und nachfolgend die entstandene Kavität mit Zement gefüllt. Hiermit wird neben der Schmerztherapie und Stabilisierung eine Reposition und Korrektur einer lokalen Kyphose angestrebt.

Dieser Artikel erläutert die Indikationen der Verfahren, wobei der Wert einer interdisziplinären Diskussion betont wird, die es erleichtert, alternative Therapien zu erwägen und die optimale Behandlung für den Patienten zu gewährleisten. In einem zweiten Schritt werden die technischen Aspekte der Verfahren erläutert und potenzielle Komplikationen der Verfahren dargestellt. Schließlich werden die Therapieresultate der PVP und der KP unter Bezugnahme auf die bislang publizierten Arbeiten und eigene Erfahrungen dargestellt und diskutiert.

>Abstract

With percutaneous vertebroplasty, a minimal invasive method, bone cement is injected under radiological control into a vertebra. The technique was first applied for treatment of aggressive hemangiomas. Today, osteoporotic compression fractures and other vertebral pathologies that cause pain - foremost metastasis - are the main indications for PVP. Kyphoplasty (KP) is closely related to PVP; with this technique expandable balloons are introduced into a vertebra and the cavity is then filled with bone cement. Apart from pain treatment and stabilisation of the vertebra, the aim of the method is to restore and correct a local kyphosis.

In this article the indications for both PVP and KP are discussed and the value of an interdisciplinary discussion that takes alternative therapeutic methods into account is stressed. Additionally, the technical aspects and the potential complications of the methods are explained. Finally, the therapeutic results of PVP and KP are reviewed in light of published results and our own experiences.

Percutaneous vertebroplasty; Kyphoplasty; Osteoporosis; Spinal tumors

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