Vertebroplastie und Kyphoplastie bei osteoporotischen Wirbelkörperfrakturen - Eine prospektive Analyse der Einjahresergebnisse

Gradl²,

et al. 2013

Fortschr Röntgenstr

Purpose: Determining whether implantation of an expandable titanium mesh cage (Osseofix? system) is a successful and safe minimally invasive therapy for osteoporotic and tumorous vertebral compression fractures (VCFs). Materials and Methods: 32 patients (25 women, 7 men, mean age 71) with 46 osteoporotic or tumorous VCFs (T6 to L4) from June 2010 to January 2012 were included. All of them were stabilized with the Osseofix? system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). The clinical and radiological results were evaluated preop, postop and 12 months postop based on the visual analog scale (VAS) and the Oswestry Disability Index (ODI), X-ray (Beck Index, Cobb angle) and CT. Results: There was a significant improvement in pain intensity (VAS) (7.8 to 1.6) as well as a?significant reduction in the mean ODI (71.36?% to 30.4?%) after 12 months. The mean kyphotic angle according to Cobb showed significant improvements (12.3? to 10.8?) after 12 months. Postinterventional imaging showed one case of loss of height in a stabilized lumbar vertebral body (2.2?%) in osteoporosis and one case with adjacent fracture (2.2?%) in osteoporosis. We saw no changes in the posterior vertebral wall. Except for one pronounced postoperative hematoma, we saw no surgical complications including no cement leakage. Conclusion: The clinical mid-term results are good at a low complication rate. The stabilization of symptomatic osteoporotic and tumorous VCFs with the Osseofix? system is a safe and effective procedure, even in fractures with posterior wall involvement. The Osseofix? system is an interesting alternative to the established procedures of cement augmentation. Key Points: ??The Osseofix? system is well suited for stabilizing osteoporotic and tumorous VCFs. ??It is a safe and effective procedure without cement leakage and with a low complication rate. ??The procedure is an interesting alternative to established cement augmentation procedures. Citation Format: ??Ender SA, Gradl G, Ender M et?al. Osseofix? System for Percutaneous Stabilization of Osteoporotic and Tumorous Vertebral Compression Fractures ? Clinical and Radiological Results After 12 Months. Fortschr R?ntgenstr 2014; 186: 380???387

Section: Special Complicationscontrasting

confidence: 36%

“…The average Cobb angle (γ-angle) improved significantly from a preoperative angle of 12.3°to 10.8°after 12 months. Comparable values for vertebroplasty have been reported [18]. However, significantly better values for kyphoplasty with an average improvement of the Cobb angle of 8°have been found in some cases [18,25].…”

Section: Special Complicationsmentioning

confidence: 79%

Osseofix® System for Percutaneous Stabilization of Osteoporotic and Tumorous Vertebral Compression Fractures – Clinical and Radiological Results After 12 Months

Gradl²,

et al. 2013

Fortschr Röntgenstr

“…Theoretically, improvement in spinal alignment will reduce the flexion moments around the affected vertebrae and relax the paraspinal muscles, leading to more upright posture, reduced pain, and fewer subsequent fractures. Studies give [40,[65][66][67][68]. Insufficient study data made it difficult to perform a statistical analysis to test for a relationship, so the question still remains.…”

Section: Height Restoration/kyphotic Angle Reductionmentioning

confidence: 99%

Comparing effects of kyphoplasty, vertebroplasty, and non-surgical management in a systematic review of randomized and non-randomized controlled studies

et al. 2012

Purpose To determine if differences in safety or efficacy exist between balloon kyphoplasty (BKP), vertebroplasty (VP) and non-surgical management (NSM) for the treatment of osteoporotic vertebral compression fractures (VCFs). Methods As of February 1, 2011, a PubMed search (key words: kyphoplasty, vertebroplasty) resulted in 1,587 articles out of which 27 met basic selection criteria (prospective multiple-arm studies with cohorts of C20 patients).This systematic review adheres to preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines.Results Pain reduction in both BKP (-5.07/10 points, P \ 0.01) and VP (-4.55/10, P \ 0.01) was superior to that for NSM (-2.17/10), while no difference was found between BKP/VP (P = 0.35). Subsequent fractures occurred more frequently in the NSM group (22 %) compared with VP (11 %, P = 0.04) and BKP (11 %, P = 0.01). BKP resulted in greater kyphosis reduction than VP (4.88 vs. 1.7°, P \ 0.01). Quality of life (QOL) improvement showed superiority of BKP over VP (P = 0.04), along with a trend for disability improvement (P = 0.08). Cement extravasation was less frequent in the BKP (P = 0.01). Surgical intervention within the first 7 weeks yielded greater pain reduction than VCFs treated later. Conclusions BKP/VP provided greater pain relief and fewer subsequent fractures than NSM in osteoporotic VCFs. BKP is marginally favored over VP in disability improvement, and significantly favored in QOL improvement. BKP had a lower risk of cement extravasation and resulted in greater kyphosis correction. Despite this analysis being restricted to Level I and II studies, significant heterogeneity suggests that the current literature is delivering inconsistent messages and further trials are needed to delineate confounding variables.

“…In a prospective but not randomized trial a more pronounced reduction of the kyphotic angle could be achieved by kyphoplasty but only in fractures younger than two weeks. Concerning pain reduction and the activities of daily life no difference between the two procedures could be found [6].…”

Section: Increase In Vertebral Heightmentioning

confidence: 95%

“…Also a pathological signal on MRI is a key finding. Especially in rather recent fractures bone marrow edema on fat-suppressed T2-weighted sequences (STIR) or the accumulation of contrast medium on fat-suppressed T1-weighted sequences are very helpful [6]. In chronic frac- tures the existence of a marrow edema did not prove to be helpful in the prediction of a successful procedure [7].…”

Section: Selection Of Patientsmentioning

confidence: 99%

Percutaneous Vertebroplasty

Warmuth‐Metz

2006

Clin Neuroradiol

Since the first description of vertebroplasty by Deramond and Galibert this minimally invasive procedure has gained wide acceptance especially for the treatment of osteoporotic subacute and chronic vertebral fractures. An accurate selection of patients and levels to treat provides very good results. After the correct placement of the needle an optimal visualisation of the cement injection and the appropriate preparation and handling of the cement are key factors to minimize the number of potentially devastating complications, which can consist of death or severe neurological damage. The alternative method of kyphoplasty could possibly lead to a better restoration of the vertebral body but unfortunately, direct comparison between the methods is not possible because randomized trials are still missing.