Vertebral body fractures / vertebral body fractures due to osteoporosis
Vertebroplasty: stabilization of the vertebral body when it comes to vertebral body fractures or as a prevention measure in case of impending vertebral body fractures by injecting bone cement percutaneously into a fractured vertebra in order to stabilize it without balloon kyphoplasty.
Kyphoplasty: Kyphoplasty surgery is designed to treat pain and other symptoms caused by a spine fracture from osteoporosis. The vertebral body needs to be stabilized due to complaints arising from vertebral body fractures or as a prevention measure in case of impending vertebral body fractures by injecting bone cement percutaneously into a fractured vertebra in order to stabilize including balloon kyphoplasty.
weiter zur Entstehung...In comparison to the vertebralplasty (1987) that was originally developed for the treatment of vertebral body haemangioblastoma, the kyphoplasty was especially developed for the treatment of vertebral body fractures.
A greater part of the patients suffering from vertebral body fractures accompanied by rarefaction of the bones become pain-free by an adequate pain therapy and physiotherapy. However, approximately 10 to 20% of the patients suffer from chronic back pain. After exclusion of other causes there is an indication for a medical treatment with either a kyphoplasty or a vertebroplasty.
The following diseases are successfully treated by means of vertebroplasty and kyphoplasty:
- Recently diagnosed vertebral body fractures (spontaneous fractures)
- Recently diagnosed traumatic vertebral body fractures
- Neoplastic vertebral compression fractures (caused by tumours or metastasis)
Vertebral body fractures in combination with osteoporosis
Approximately 5 million people in Germany suffer from a pathogen bone loss called osteoporosis. Vertebral body fractures belong to the most common complications when it comes to an advanced osteoporosis. Patients suffer from acute and chronic back pains that in past were treated conservatively by means of pain medication or orthopaedic devices like corsages, braces.
Meanwhile we have the kyphoplasty as a successful operation method to restore the structure and stability of the vertebral body that leads to a considerable pain reduction as well as preventing the already injured vertebral body from collapsing
The possibility of a kyphoplasty treatment of the vertebral body does by far not replace a systemic osteoporosis therapy. The fractures to the vertebral body mostly occur on the thoracic lumbar vertebra bridge which means the passage of the kyphosis into the lordose. Due to the changes happen to the curvature of the spine, the vertebral body is exposed to a considerable loading. This is the explanation for the cumulative occurrence of vertebral body fractures in this area of the spine.
Traumatic vertebral body fractures (caused by accidents)
The traumatic vertebral body fractures differ considerably from vertebral body fractures in the course of an osteoporosis. As the vertebral body fractures in the course of an osteoporosis occur spontaneously, insidiously or followed after bagatelle injury, the traumatic vertebral body fracture is occurring in the course of a considerable force trauma. Consequently we differentiate between different types of fractures; however, in the course of a traumatic vertebral body fracture we have considerably more complex vertebral body fractures with relatively more severe concomitant injuries like damages to the spinal cord, damages to the intervertebral disk or damages to the ligaments. Complex vertebral body fractures and those with considerable concomitant injuries can not be treated with kyphoplasty. In those cases other wide-ranging stabilizing operation techniques become necessary.
Anyway, the kyphoplasty as a medical treatment for traumatic vertebral body fractures is not yet been applied routinely. Up to now we do not have sufficient long-time medical experience to apply this method as a standardized medical treatment in the course of traumatic vertebral body fractures.
The conceivable best form of fracture to the vertebral body is for sure the very recent diagnosed compression fracture to the vertebral body without any severe concomitant injuries. It is recommended due to the already made experiences with vertebral body fracture in the course of an osteoporosis that an operation is made early because empirically only in this stage a satisfying re-erection of the compressed vertebral body can be achieved. Vertebral body fractures with concomitance of their trailing edge (in the direction of the spinal cord) are an absolute contraindication for the appliance of a kyphoplasty as well as a vertebroplasty.
Neoplastic vertebral body fractures
The vertebroplasty was developed for the stabilization of a vertebral haemangioma (benign tumour of the vertebral body, developing out of a proliferated growth of a vessel). Its appliance has been medically approved. The kyphoplasty applied with malignant tumours is mainly seen in the medical therapy of disseminated tumours by oteolytic (bone-dissolving) tumours when an operative treatment in the area of the spine is not possible anymore. Authors refer to a theoretically possible venous dissemination of malignant vertebral body tumours when suppressing the tumour tissue by means of a balloon catheter.
A decided advantage is the relatively small operative procedure and therefore an almost undelayed possibility for continuing the ongoing radiation and/or chemotherapy.
zurück zur Definition...
The microsurgical “half-opened” technique is applied in the field of concomitant diseases or difficult anatomic conditions in the operation field which makes the operation more complicated.
A 5 centimetre long incision is made under general anaesthetic. Through a better sight of the operator in the operation field, concomitant injuries can also be treated or medical complications like an unwanted bone cement release into the spinal canal can be corrected immediately. Unfavourable is the higher risk of trauma to the soft tissue and therefore a longer convalescence for the patient and the necessity of a general anaesthesia.
When it comes to the percutaneous operation technique it can be operated under general anaesthesia as well as under local anaesthesia.
All the following described operation steps are made chronologic and on both sides.
A stab incision is made from backwards (1 – 2 centimetre long skin incision) and a long cannula is inserted into the fractured vertebral body. All is made under radiographical monitoring.
By means of this cannula a guide wire is shuffled that is acting as a conductor rail for the now interjectional working channel.
When placing the working channel is must be observed that no damage is done to the vertebral body wall because otherwise the later injected bone cement could escape.
By use of a drill wire a storage place in the vertebral body for the balloon kyphoplasty is made and afterwards the balloon kyphoplasty is inserted. Step by step the balloon is filled with contrast medium and the collapsed vertebral body is lifted up until a satisfying correction could be achieved. After achieving the vertebral body re-erection the balloon is removed. This balloons leaves an osseous cavity that is filled with viscous bone cement (PMMA=polymethylmethacrylat) by using low pressure. The filling volume depends on the lately achieved volume of the balloon kyphoplasty (approx. 8 to 12 ml).
The duration of the operation depends on the number of vertebral bodies that need to be operated. If only one vertebral body needs to be operated the operation time is about 30 to 34 minutes. The patient is mobilizable one day after the operation has taken place. Normally the considerable pain reduction is recognized immediately.
When it comes to vertebroplasty the vertebral body is filled with bone cement without having a ballon kyphoplasty in advance. Due to the fact that no osseous cavity was made before, the liquid bone cement muss be injected under high pressure into the vertebral body in order to have it allocated adequately.
zurück zur Entstehung...
