Indikationen zur konservativen Behandlung von Wirbelfrakturen

A realistic comparison of the results of conservative and of operative treatment is hardly possible at present, since the data in the literature have not been classified according to any uniformly adopted system, no prospective comparative studies are reported, a great many different treatment methods have been used, suitable instruments were not available for quantification of study results, and late results are available only in isolated cases. According to the AO fracture classification, compression fractures of types A1 and A2 are definite indications for conservative procedures. In the case of a highly unstable multifragmentary fracture (A2.3) an operative procedure can become necessary. Burst fractures (A3) and more unstable injuries must be surgically treated from the first. Vertebral augmentation is now available as a middle way between conservative and operative treatment. It is indicated in the case of painful osteoporotic or osteolytic compression fractures in the thoracic or lumbar spine originating from primary or secondary osteoporosis or from osteolytic metastases. In contrast to vertebropasty, kyphoplasty offers the possibility of fracture realignment as well as the definite pain relief it affords.