Kyphoplastie und Vertebroplastie in der Behandlung von Wirbelkörperfrakturen

Abstract

Kyphoplasty and vertebroplasty have become established and frequently used surgical procedures for the treatment of vertebral body fractures. The number of surgeons performing these techniques with filling and augmentation of vertebral bodies with bone cement is increasing. This fact is based on the advantage that both procedures achieve fast therapeutic success by using a minimally invasive access with a limited risk for the patient. Furthermore, it has to be considered that due to economic reasons many hospitals want and have to offer these surgical options. Uncritical indications as well as insufficient experience in the conservative and surgical treatment of vertebral fractures are the leading causes for bad outcome and failure of these techniques. Due to a lack of randomised studies there is no reliable differentiation between both procedures regarding short- and long-term success in pain reduction, restoration of vertebral height or complications. Painful osteoporotic vertebral body compression fractures are regarded as the only evaluated indications for kyphoplasty and vertebroplasty; in contrast neither procedure is indicated in traumatic fractures in patients without osteoporosis. In elderly patients with painful vertebral fractures and adequate trauma additional posterior instrumentation is beneficial.