Introduction There is still no general consensus about the management of osteoporotic vertebral fractures. Recommendations depend on type of fracture, grade of instability, bone quality, and general conditions of the patient. Spontaneous fractures may be considered to be treated different compared to cases with high-velocity trauma. Methods According to the DVO, patients without trauma should first be treated conservatively. However, there is no more strict time protocol of 3 or 6 week conservative treatment before operations may be indicated. Surgical criteria are not yet distinctly defined. For highly unstable fractures (type B and C according to the AO Spine Classification), posterior instrumentation with cement augmented screws and as long construct, respectively, is adequate. Current literature has been analysed for diagnostic and therapeutic protocols. Results There is no clear operative concept for burst fractures and classic osteoporotic fractures with dynamic ongoing sintering. Percutaneous vertebral augmentation showed to prevent the fractures from ongoing kyphotic deformity and the patients from painful immobilization. Indications and results of classical vertebroplasty and kyphoplasty have been discussed intensively in the literature. Further development included special injection techniques, cements with different viscosities and stenting systems to reach more stable constructs and avoid typical complications, such as cement extrusion. Conclusions This review reports upon indications and limitations of percutaneous vertebral augmentation and the potential development of classifications and therapeutic algorithms.

Instabile Verletzungen an der Halswirbelsäule sind häufig auf zerrissene Bandscheiben zurückzuführen und über einen ventralen Zugang durch monosegmentale Fusion standardisiert zu stabilisieren. Komplexer wird die Fragestellung, wenn erhebliche Dislokationen, hochinstabile Verletzungen mit Beteiligung des dorsalen Bandapparates oder gar Luxationsverletzungen vorliegen. Auch hier ist regelhaft zunächst von ventral vorzugehen, man muss aber auch auf eine dorsale Reposition und Osteosynthese (einzeitig oder zweizeitig) vorbereitet sein. In Ausnahmefällen kann sogar ein einzeitiges ventrodorsoventrales Vorgehen erforderlich werden. Ein primär dorsales Vorgehen ist indiziert wenn die Hauptpathologie dorsal liegt oder der ventrale Zugang nicht möglich ist, auch hier ggf. kombiniert in gleicher Sitzung oder zweizeitig.

Fractures of the thoracic and lumbar spine result from high velocity trauma, assuming bone density is normal. The main location of fractures is the thoracolumbar junction. Most injuries can be treated conservatively; however, patients transferred to hospitals and spine centers represent a preselection with more severe trauma and a higher incidence of operative treatment. There is a large variety of operative techniques that can be used, which can be principally differentiated by the approach: posterior or anterior. Dorsal approaches are differentiated by the instrumentation for spondylodesis as open or percutaneous techniques. Minimally invasive options are favored more and more. For osteoporotic bone, cement augmented solutions may be used. Correct reduction of mainly kyphotic malalignment is crucial for the long-term outcome. Biomechanically stable reconstruction of the anterior spinal column is important mainly for the thoracolumbar junction.

Ziel dieser Untersuchung war es, die Repositionsmöglichkeiten eines perkutanen Fixateur interne an der Wirbelsäule zu evaluieren. Ein Hauptkritikpunkt der perkutanen Fixateure ist die mangelnde Repositionsmöglichkeit, welche zwischenzeitlich allerdings durch monoaxiale Schrauben und Repositionshilfen deutlich verbessert wurde.

Since the first use of instrument-tracking techniques in the early 1990s, image-guided technologies became a leading topic in all branches of spine surgery. Today, navigation is a widely available tool in spine surgery and has become a part of clinical routine in many centers for a large variety of indications. Spinal navigation may not only contribute to more precision during surgery, but it may also reduce radiation exposure and fluoroscopy time, with advantages not only for the patient but also for the operating room personnel. Different registration algorithms have been developed differing in terms of the type of image data used by the navigation system (preoperatively acquired computed tomography [CT] images, intraoperatively acquired fluoroscopy images) and the way virtual and physical reality is matched. There is a tendency toward a higher accuracy for 3D fluoroscopy-based registration algorithms. The O-arm® represents a new flat-panel technology with the source and detector moving in a 360° arc around the patient. In combination with the Stealth® station system, navigation may start immediately after automated registration with already referenced instruments. After instrumentation, an additional scan may confirm intraoperatively the correct positioning of the instrumentation. The first experiences with the system are described in this paper.

The morbidity of anterior approaches has significantly influenced the development of therapeutic concepts for the treatment of thoracolumbar spine fractures. Minimally-invasive techniques such as mini-open and endoscopic have enlarged the numbers of anterior reconstruction after spinal fractures in the thoracolumbar region. These minimally-invasive approaches have been facilitated by the development of special implants adapted to the new technique and to the local anatomical requirements.Two multi center studies in Germany (MCSI and II) showed the trend towards minimal invasive procedures and anterior approaches in the German speaking spine centers. Since the first report on thoracoscopic anterior procedures in Germany in 1997 a growing number of spine centers established this method. There is still no evidence based high level literature to substantiate a significant benefit for the patients by anatomical reduction and reconstruction of the anterior spinal column. However, there are some reports on better short outcomes in radiological parameters as well as better clinical results in 5 to 8 year follow-ups.The minimal invasive anterior approach seems to be advantageous for the patients by reducing significantly additive operation morbidity. It has become more important over the last two decades for anterior reconstruction after trauma and posttraumatic malalignment of the thoracolumbar spine.

Die Morbidität der ventralen Zugänge hat die Entwicklung therapeutischer Konzepte zur Behandlung von Wirbelsäulenverletzungen im thorakolumbalen Bereich wesentlich beeinflusst. Durch die Entwicklung von minimal-invasiven Verfahren in endoskopischer oder reduziert invasiver Technik hat die Rekonstruktion der ventralen Säule nach Verletzungen der thorakalen und lumbalen Wirbelsäule im Laufe der letzten beiden Dekaden eine enorme Bedeutungszunahme erfahren. Neben der Entwicklung minimal-invasiver Zugangstechniken spielen hier speziell für diese Verfahren konzipierte Implantate, die den Anforderungen der minimal-invasiven Techniken und der lokalen anatomischen Gegebenheiten entsprechen können, eine wesentliche Rolle.