Skip to main content
Log in

Vertebroplastie zur Therapie des Rückenschmerzes

Vertebroplasty in the treatment of back pain

  • Rückenschmerz: Diagnostik und Intervention
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die perkutane Vertebroplastie (PVP) stellt bei osteoporotischen Wirbelkörperfrakturen (WKF) und Osteolysen der Wirbelsäule eine minimalinvasive Behandlungsmöglichkeit dar, die zunehmend an Bedeutung gewinnt. In diesem Beitrag sollen Indikationsstellung, periinterventionelle Bildgebung, Technik und klinische Ergebnisse der PVP dargestellt werden.

Material und Methoden

Gemäß dem „Interdisziplinären Konsensuspapier zur Vertebro- und Kyphoplastie“ der deutschen Fachgesellschaften sowie den Leitlinien der CIRSE aus dem Jahr 2005 werden die aktuellen Richtlinien zur Durchführung der PVP erläutert. Die Ergebnisse einer eigenen Studie werden Komplikationsraten und klinischen Ergebnissen in der Literatur gegenübergestellt.

Ergebnisse

Die Indikation zur PVP besteht bei schmerzhaften osteoporotischen WKF und Wirbelkörperosteolysen durch Metastasen und das multiple Myelom. Absolute Kontraindikationen sind v. a. asymptomatische WKF, eine Beschwerdelinderung unter medikamentöser Therapie, therapierefraktäre Koagulopathien, Allergien gegen Zementbestandteile und aktive Infektionen. Zur Abschätzung des Frakturalters, Ausschluss anderer Schmerzursachen und Beurteilung der Wirbelkörperhinterkante sind vor der PVP eine MRT bzw. CT indiziert. Eine qualitativ hochwertige mono- oder biplanare Fluoroskopie – möglichst in Kombination mit der CT(-Fluoroskopie) – sind bei der PVP erforderlich, um das Risiko von Zementleckagen zu minimieren. Bei 86–92% der Patienten wird durch die PVP eine deutliche Schmerzreduktion (mittlere Abnahme von 6,1 Punkten [VAS]) erreicht. Eine eigene Studie mit 58 behandelten Patienten (mittlerer Beobachtungszeitraum 323+/−99 Tage) zeigte in 77% der Fälle eine deutliche Beschwerdelinderung (−5,7 Punkte [VAS]).

Schlussfolgerung

Die PVP ermöglicht bei akutem und chronischem Rückenschmerz durch osteoporotische WKF und tumorbedingte Osteolysen eine sichere und effektive minimalinvasive Therapie zur Stabilisierung und Schmerzreduktion.

Abstract

Background

Percutaneous vertebroplasty (PVP) represents a minimally invasive option which is gaining in importance for the treatment of vertebral compression fractures (VCF) and osteolysis of the spine. This article describes the indications for its use, peri-interventional imaging, technique, and results of PVP.

Material and methods

The current guidelines for performance of PVP are explained in accordance with the “Interdisciplinary Consensus Paper on Vertebroplasty and Kyphoplasty” of the German Professional Associations and the 2005 CIRSE Guidelines. The results of our own study carried out in 2002 are compared to the complication rates and clinical outcomes reported in the literature.

Results

Painful osteoporotic VCF and osteolysis within the vertebral body due to metastases and multiple myeloma are indications for PVP. Absolute contraindications are, in particular, asymptomatic VCF, alleviation of pain by drug treatment, therapy-refractory coagulopathies, allergies to cement components, and active infections. MRI or CT is indicated before undertaking PVP to assess the fracture age, to exclude other causes of pain, and to evaluate the posterior edge of the vertebral body. High-quality mono- or biplanar fluoroscopy – preferably in combination with CT (fluoroscopy) – is necessary for PVP to minimize the risk of cement leakage. A clear reduction in pain [mean reduction of 6.1 points (VAS)] is achieved in 86–92% of the patients with PVP. Our own study treating 58 patients (mean follow-up 323±99 days) revealed a clear alleviation of pain in 77% [−5.7 points (VAS)].

Conclusion

PVP constitutes a safe and effective minimally invasive treatment approach to stabilize and reduce acute and chronic back pain due to osteoporotic VCF and tumor-associated osteolysis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1 a
Abb. 2 a
Abb. 3 a
Abb. 4

Literatur

  1. Bartolozzi B, Nozzoli C, Pandolfo C et al. (2006) Percutaneous vertebroplasty and kyphoplasty in patients with multiple myeloma. Eur J Haematol 76: 180–181

    Article  PubMed  Google Scholar 

  2. Baur A, Stabler A, Bruning R et al. (1998) Diffusion-weighted MR imaging of bone marrow: differentiation of benign versus pathologic compression fractures. Radiology 207: 349–356

    PubMed  Google Scholar 

  3. Bouza C, Lopez T, Magro A et al. (2006) Efficacy and safety of balloon kyphoplasty in the treatment of vertebral compression fractures: a systematic review. Eur Spine J January 21; 1–18 [Epub ahead ofprint]

    Google Scholar 

  4. Brown DB, Gilula LA, Sehgal M et al. (2004) Treatment of chronic symptomatic vertebral compression fractures with percutaneous vertebroplasty. AJR Am J Roentgenol 182: 319–322

    PubMed  Google Scholar 

  5. Cortet B, Cotten A, Boutry N et al. (1999) Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26: 2222–2228

    PubMed  Google Scholar 

  6. Cotten A, Dewatre F, Cortet B et al. (1996) Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. Radiology 200: 525–530

    PubMed  Google Scholar 

  7. Deramond H, Depriester C, Galibert P et al. (1998) Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 36: 533–546

    Article  PubMed  Google Scholar 

  8. Diamond TH, Champion B, Clark WA (2003) Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114: 257–265

    Article  PubMed  Google Scholar 

  9. Ehrlich GE (2003) Back pain. J Rheumatol 67 [suppl]: 26–31

  10. Evans AJ, Jensen ME, Kip KE et al. (2003) Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology 226: 366–372

    PubMed  Google Scholar 

  11. Galibert P, Deramond H, Rosat P et al. (1987) [Preliminary note on the treatment of vertebral angioma by percutaneous acrylic vertebroplasty]. Neurochirurgie 33: 166–168

    PubMed  Google Scholar 

  12. Gangi A, Guth S, Imbert JP et al. (2003) Percutaneous vertebroplasty: indications, technique, and results. Radiographics 23: e10

    PubMed  Google Scholar 

  13. Gangi A, Sabharwal T, Irani FG et al. (2005) Quality assurance guidelines for percutaneous vertebroplasty. Cardiovasc Intervent Radiol 29: 173–178

    Article  Google Scholar 

  14. Grados F, Depriester C, Cayrolle G et al. (2000) Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology (Oxford) 39: 1410–1414

    Google Scholar 

  15. Hadjipavlou AG, Tzermiadianos MN, Katonis PG et al. (2005) Percutaneous vertebroplasty and balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures and osteolytic tumours. J Bone Joint Surg [Br] 87: 1595–1604

    Google Scholar 

  16. Heaney RP (2003) Advances in therapy for osteoporosis. Clin Med Res 1: 93–99

    PubMed  Google Scholar 

  17. Heini PF, Walchli B, Berlemann U (2000) Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 9: 445–450

    Article  PubMed  Google Scholar 

  18. Heini PF, Berlemann U (2001) Bone substitutes in vertebroplasty. Eur Spine J 10 [suppl 2]: S205–213

  19. Helmberger T, Bohndorf K, Hierholzer J et al. (2003) Leitlinien der deutschen Röntgengesellschaft zur Vertebroplastie. Radiologe 43: 703–708

    Article  PubMed  Google Scholar 

  20. Hiwatashi A, Sidhu R, Lee RK et al. (2005) Kyphoplasty versus vertebroplasty to increase vertebral body height: a cadaveric study. Radiology 237: 1115–1119

    PubMed  Google Scholar 

  21. Hodler J, Peck D, Gilula LA (2003) Midterm outcome after vertebroplasty: predictive value of technical and patient-related factors. Radiology 227: 662–668

    PubMed  Google Scholar 

  22. Hoffmann RT, Jakobs TF, Ertl-Wagner BB et al. (2003) Stellenwert der Vertebroplastie bei osteoporotisch bedingten Wirbelkörperfrakturen. Radiologe 43: 729–734

    Article  PubMed  Google Scholar 

  23. Interdisziplinäres Konsensuspapier zur Vertebroplastie/Kyphoplastie (2005) Fortschr Röntgenstr 177: 1590–1592

  24. Jensen ME, Evans AJ, Mathis JM et al. (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 18: 1897–1904

    PubMed  Google Scholar 

  25. Liebschner MA, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26: 1547–1554

    Article  PubMed  Google Scholar 

  26. Masala S, Roselli M, Massari F et al. (2004) Radiofrequency heat ablation and vertebroplasty in the treatment of neoplastic vertebral body fractures. Anticancer Res 24: 3129–3133

    PubMed  Google Scholar 

  27. Masala S, Schillaci O, Massari F et al. (2005) MRI and bone scan imaging in the preoperative evaluation of painful vertebral fractures treated with vertebroplasty and kyphoplasty. In Vivo 19: 1055–1060

    PubMed  Google Scholar 

  28. Mathis JM, Barr JD, Belkoff SM et al. (2001) Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol 22: 373–381

    PubMed  Google Scholar 

  29. McGraw JK, Lippert JA, Minkus KD et al. (2002) Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol 13: 883–886

    PubMed  Google Scholar 

  30. McGraw JK, Cardella J, Barr JD et al. (2003) Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol 14: S311–315

    PubMed  Google Scholar 

  31. Nussbaum DA, Gailloud P, Murphy K (2004) A review of complications associated with vertebroplasty and kyphoplasty as reported to the Food and Drug Administration medical device related web site. J Vasc Interv Radiol 15: 1185–1192

    PubMed  Google Scholar 

  32. O’Neill TW, Cockerill W, Matthis C et al. (2004) Back pain, disability, and radiographic vertebral fracture in European women: a prospective study. Osteoporos Int 15: 760–765

    PubMed  Google Scholar 

  33. Peh WC, Gilula LA, Peck DD (2002) Percutaneous vertebroplasty for severe osteoporotic vertebral body compression fractures. Radiology 223: 121–126

    PubMed  Google Scholar 

  34. Phillips FM, Todd Wetzel F, Lieberman I et al. (2002) An in vivo comparison of the potential for extravertebral cement leak after vertebroplasty and kyphoplasty. Spine 27: 2173–2178; discussion 2178–2179

    Article  PubMed  Google Scholar 

  35. Stallmeyer MJ, Zoarski GH, Obuchowski AM (2003) Optimizing patient selection in percutaneous vertebroplasty. J Vasc Interv Radiol 14: 683–696

    PubMed  Google Scholar 

  36. Vasconcelos C, Gailloud P, Beauchamp NJ et al. (2002) Is percutaneous vertebroplasty without pretreatment venography safe? Evaluation of 205 consecutives procedures. AJNR Am J Neuroradiol 23: 913–917

    PubMed  Google Scholar 

  37. Weill A, Chiras J, Simon JM et al. (1996) Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. Radiology 199: 241–247

    PubMed  Google Scholar 

  38. White SM (2002) Anaesthesia for percutaneous vertebroplasty. Anaesthesia 57: 1229–1230

    Google Scholar 

Download references

Interessenkonflikt

Es besteht kein Interessenkonflikt. Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen. Die Präsentation des Themas ist unabhängig und die Darstellung der Inhalte produktneutral.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to C. G. Trumm.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Trumm, C.G., Jakobs, T.F., Zech, C.J. et al. Vertebroplastie zur Therapie des Rückenschmerzes. Radiologe 46, 495–505 (2006). https://doi.org/10.1007/s00117-006-1382-7

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-006-1382-7

Schlüsselwörter

Keywords

Navigation