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Mathias C. Pippan, Marcus Richter |
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The treatment of osteoporotic vertebral body fractures often requires a well-thought-out therapeutic strategy. Most of the patients are at older age and multimorbid, so that therapy should be as gentle as possible. On the other hand, an early surgical stabilization to avoid immobilization of the patients often is necessary. Kyphoplasty and vertebroplasty are established minimal invasive procedures in the therapy of osteoporotic vertebral fractures. In literature the outcome after cement augmentation is quite good and the complication rate, especially in kyphoplasty, is low. In cases of a total collapse of the vertebral body, in older fractures with kyphotic deformity or in cases of instability, a posterior instrumentation with an anterior column support is needful. Due to the fact that there is no comparative long-term evidence-based data in literature concerning the different implants, general recommendations cannot be given. To avoid implant failure we propose an additional instrumentation of the adjacent vertebral bodies within the posterior stabilization and – if procurable – we always do an anterior column support with an expandable titanium cage. Furthermore, a pedicle screw system which allows cement augmentation of the screws after placement of the screws could be helpful to elevate the stability of the instrumentation. Further clinical examinations have to be carried out. |
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