Vertebroplastie: ein Update

Abstract

Percutaneous cement augmentation (kyphoplasty and vertebroplasty) has become established as a procedure for treatment of painful osteoporotic vertebral fractures and certain neoplastic changes. The injection of cement ensures rapid stabilization of the vertebra and prevents further sintering. This also results in pain improvement. Nonetheless, based on two placebo-controlled trials, this treatment approach has been called into question. However, these studies did not take the technical aspects of the treatment into consideration, and it appears probable that the amount of filler material chosen was too small so that the treatment group also received placebo. Furthermore, it is likely that mostly older fractures were treated so that the effect can no longer be expected to be as pronounced. A randomized, controlled trial comparing kyphoplasty to conservative management provided good evidence that cement augmentation is of benefit within the first year. Newer procedures for kyphoplasty are very promising, but their clinical significance still needs verification.

Reinforcement Strategies for Load-Bearing Calcium Phosphate Biocements

“…An extension of the application of calcium phosphate cements to load-bearing defects, e.g., in vertebroplasty or kyphoplasty [31,32,33], would require less brittle cements with an increased fracture toughness. This is of high interest since the application of commonly used polymeric cements have strong drawbacks near the spinal cord due to their strong exothermic setting reaction and cytotoxic monomer release [34,35,36]. Common approaches to reduce brittleness of CPC and to improve their mechanical performance for load-bearing applications cover the modification of the cement liquid with polymeric additives such as collagen [37,38,39,40], the addition of fibres to the cement matrix [41,42] or the use of dual-setting cements in which a dissolved monomer is simultaneously cross-linked during cement setting [43,44,45] (Figure 1).…”