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Degeneration und Osteoporose der Wirbelsäule

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Degeneration and Osteoporosis of the Spine

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Zusammenfassung

Eine reduzierte Knochenqualität infolge einer Osteoporose stellt eine wesentliche Problematik bei der instrumentierten Wirbelsäulenchirurgie dar. Die zunehmende Ausweitung der Operationsindikationen auf ältere und alte Patienten führt im klinischen Alltag zu einer großen Relevanz dieser Problematik. Eine insuffiziente Implantatverankerung sowie die Anschlussfraktur sind die häufigsten beobachteten Folgen. Bei einer manifesten Osteoporose stehen verschiedene moderne Verankerungsmöglichkeiten zur Verfügung. Zementierbare Schrauben, die Kombination von Pedikelschrauben und Hakenverankerungen (Hybridinstrumentation), ein verändertes Schraubendesign und spezielle chirurgische Techniken können die Stabilität der Instrumentation mehr oder weniger erhöhen. Ob additiv applizierte Bisphosphonate die Verankerung tatsächlich verbessern, ist bislang noch nicht bewiesen. Die Zementaugmentation eines frakturierten Wirbels mittels Kypho- oder Vertebroplastie führt gegenüber einer konservativen Behandlung nachweislich zu einer signifikant besseren Schmerzreduktion, zumindest im kurzfristigen postoperativen Verlauf. Ein Verfahrensunterschied ist diesbezüglich bislang nicht nachgewiesen. Die Rate der sog. Anschlussfrakturen ist im Vergleich zu konservativ behandelten Patienten nach erfolgter Zementaugmentation nicht erhöht.

Abstract

Reduced bone quality due to osteoporosis poses a fundamental problem in spine surgery instrumentation. The consequences observed most often are insufficient implant anchoring and adjacent fractures. In cases of manifest osteoporosis, several modern anchoring possibilities are at our disposal that, to differing degrees, increase the stability of the instrumentation. Cement augmentation of a fractured vertebra by means of kyphoplasty or vertebroplasty verifiably leads to significantly better pain reduction than conservative treatment does, at least in the short-term postoperative course. A difference between these two techniques has not yet been substantiated. The rate of adjacent fractures occurring after cement augmentation is not higher than in conservatively treated patients.

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  1. Klinik für Orthopädie und Unfallchirurgie, Universität zu Köln, Joseph-Stelzmann-Straße 9, 50924, Köln, Deutschland

    K.-S. Delank, M. Röllinghoff, K. Eysel-Gosepath, R. Sobottke & P. Eysel

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  1. K.-S. Delank
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  2. M. Röllinghoff
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  3. K. Eysel-Gosepath
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  4. R. Sobottke
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  5. P. Eysel
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Correspondence to K.-S. Delank.

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Delank, KS., Röllinghoff, M., Eysel-Gosepath, K. et al. Degeneration und Osteoporose der Wirbelsäule. Orthopäde 39, 425–431 (2010). https://doi.org/10.1007/s00132-009-1573-9

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  • DOI: https://doi.org/10.1007/s00132-009-1573-9

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