Moderne interventionelle Verfahren bei primären Knochentumoren und Knochenmetastasen

Zusammenfassung

Pathologische Wirbelkörperfrakturen und -osteolysen im Rahmen von Metastasen, eines Lymphombefalls oder des multiplen Myeloms der Wirbelsäule sind eine häufige Ursache für schwere akute bzw. chronische Rückenschmerzen von Tumorpatienten. Die perkutane Vertebroplastie (PVP) stelltgegenüberetablierten Behandlungsmethoden wie der Strahlen- und medikamentösen Schmerztherapie eine effektive und sichere, minimal-invasive Behandlungsoption mitzunehmender Bedeutung dar. Neben der Wirbelkörperstabilisierung stehen eine Schmerzreduktion und eineVerbesserung der Lebensqualität im Vordergrund. Bei 86-92 % der Patienten wird laut Literatur durch die PVP eine deutliche Schmerzreduktion erreicht, aufeiner VAS einer mittleren Abnahme von vier bis sechs Punkten entsprechend.

Das Osteoidosteom, ein gutartiger osteoblastischer Knochentumor des Kindes- und jungen Erwachsenenalters mit Bevorzugung der langen Röhrenknochen, wurde traditionell medikamentös mit nichtsteroidalen Antirheumatika und Azetylsalizylsäure oder durch offene chirurgische Kürettage bzw. En-bloc-Resektion behandelt. Minimal-invasive perkutaneVerfahren wie die Ethanolinjektion, interstitielle Laser-Photokoagulation oder Radiofrequenzablation (RFA) haben das operative Vorgehen nahezu ersetzt. Die Vorteile der RFA sind, neben einer Erfolgsquote von 79 bis 94 %, die Möglichkeit eines kurzen stationären Aufenthalts bzw. eines ambulanten Vorgehens bei niedriger Komplikationsrate.

Summary

Pathologic vertebral fracturesand osteolyses are a common reason forsevere acute or chronic back pain in patientswith metastases, lymphoma and multiple myeloma ofthe spine. Beside established methods such as radiation and analgetic therapy percutaneous vertebroplasty (PVP) represents an effective and safe, minimally-invasive therapeutic option of increasing importance. Vertebral stabilization, reduction of pain and improved quality of life are the main treatment objectives. According to the literature, in 86 to 92% of the patients a significant pain reduction (i.e. a mean reduction on VAS by 4-6 points) is accomplished. Osteoid osteoma is abenign osteoblastic bone tumor which is usually found in the major weight-bearing bones of children and young adults. Traditional treatment options are long-term administration of non-steroidal anti-inflammatory drugs, and surgical curettage or en-bloc-resection. Minimally-invasive percutaneous techniques such as ethanol injection, interstitial laser photocoagulation or radiofrequency ablation (RFA) have subsequently replaced surgery. Beside success rates of 79 to 94 %, the major advantages of RFA are short hospital stays or treatment on an outpatient basis with low complication rates.

Schlüsselwörter

Perkutane Vertebroplastie - Wirbelsäulenmetastasen - multiples Myelom - Radiofrequenzablation - Osteoidosteom

Keywords

Percutaneous vertebroplasty - spinal metastases - multiple myeloma - radiofrequency ablation - osteoid osteoma

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