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Lu HT, Lin JY, Tsuei YC, Hsu YF, Chen CY, Cheng SH, Chu W, Li C, Chu WC. Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution-An Ex Vivo Study in Goat Vertebrae. Bioengineering (Basel) 2023; 10:795. [PMID: 37508822 PMCID: PMC10376675 DOI: 10.3390/bioengineering10070795] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/22/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats' ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 ± 1.30 in contrast to 4 ± 1.78 by conventional PV.
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Affiliation(s)
- Hsin-Tzu Lu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Jia-Yi Lin
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Yu-Chuan Tsuei
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Yung-Fu Hsu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Chung-Yi Chen
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Shih-Hao Cheng
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - William Chu
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan
| | - Chuan Li
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
| | - Woei-Chyn Chu
- Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan
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Wang QD, Guo LX. Biomechanical role of cement augmentation in the vibration characteristics of the osteoporotic lumbar spine after lumbar interbody fusion. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2022; 33:52. [PMID: 35657438 PMCID: PMC9166889 DOI: 10.1007/s10856-022-06671-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
Under whole body vibration, how the cement augmentation affects the vibration characteristic of the osteoporotic fusion lumbar spine, complications, and fusion outcomes is unclear. A L1-L5 lumbar spine finite element model was developed to simulate a transforaminal lumbar interbody fusion (TLIF) model with bilateral pedicle screws at L4-L5 level, a polymethylmethacrylate (PMMA) cement-augmented TLIF model (TLIF-PMMA) and an osteoporotic TLIF model. A 40 N sinusoidal vertical load at 5 Hz and a 400 N preload were utilized to simulate a vertical vibration of the human body and the physiological compression caused by muscle contraction and the weight of human body. The results showed that PMMA cement augmentation may produce a stiffer pedicle screw/rod construct and decrease the risk of adjacent segment disease, subsidence, and rod failure under whole-body vibration(WBV). Cement augmentation might restore the disc height and segmental lordosis and decrease the risk of poor outcomes, but it might also increase the risk of cage failure and prolong the period of lumbar fusion under WBV. The findings may provide new insights for performing lumbar interbody fusion in patients affected by osteoporosis of the lumbar spine. Graphical abstract.
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Affiliation(s)
- Qing-Dong Wang
- Department of Mechanical Engineering, Tsinghua University, Beijing, China
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, 110819, China
| | - Li-Xin Guo
- School of Mechanical Engineering and Automation, Northeastern University, Shenyang, 110819, China.
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Integration of Umbilical Cord Mesenchymal Stem Cell Application in Hydroxyapatite-Based Scaffolds in the Treatment of Vertebral Bone Defect due to Spondylitis Tuberculosis: A Translational Study. Stem Cells Int 2021; 2021:9928379. [PMID: 34475959 PMCID: PMC8407992 DOI: 10.1155/2021/9928379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/01/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
Background Vertebral bone defect represents one of the most commonly found skeletal problems in the spine. Progressive increase of vertebral involvement of skeletal tuberculosis (TB) is reported as the main cause, especially in developed countries. Conventional spinal fusion using bone graft has been associated with donor-site morbidity and complications. We reported the utilization of umbilical cord mesenchymal stem cells (UC-MSCs) combined with hydroxyapatite (HA) based scaffolds in treating vertebral bone defect due to spondylitis tuberculosis. Materials and Methods Three patients with tuberculous spondylitis in the thoracic, thoracolumbar, or lumbar region with vertebral body collapse of more than 50 percent were included. The patient underwent a 2-stage surgical procedure, consisting of debridement, decompression, and posterior stabilization in the first stage followed by anterior fusion using the lumbotomy approach at the second stage. Twenty million UC-MSCs combined with HA granules in 2 cc of saline were transplanted to fill the vertebral bone defect. Postoperative alkaline phosphatase level, quality of life, and radiological healing were evaluated at one-month, three-month, and six-month follow-up. Results The initial mean ALP level at one-month follow-up was 48.33 ± 8.50 U/L. This value increased at the three-month follow-up but decreased at the six-month follow-up time, 97 ± 8.19 U/L and 90.33 ± 4.16 U/L, respectively. Bone formation of 50-75% of the defect site with minimal fracture line was found. Increased bone formation comprising 75-100% of the total bone area was reported six months postoperation. A total score of the SF-36 questionnaire showed better progression in all 8 domains during the follow-up with the mean total score at six months of 2912.5 ± 116.67 from all patients. Conclusion Umbilical cord mesenchymal stem cells combined with hydroxyapatite-based scaffold utilization represent a prospective alternative therapy for bone formation and regeneration of vertebral bone defect due to spondylitis tuberculosis. Further clinical investigations are needed to evaluate this new alternative.
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Kinne RW, Gunnella F, Kunisch E, Heinemann S, Nies B, Maenz S, Horbert V, Illerhaus B, Huber R, Firkowska-Boden I, Bossert J, Jandt KD, Sachse A, Bungartz M, Brinkmann O. Performance of Calcium Phosphate Cements in the Augmentation of Sheep Vertebrae-An Ex Vivo Study. MATERIALS 2021; 14:ma14143873. [PMID: 34300793 PMCID: PMC8307240 DOI: 10.3390/ma14143873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/25/2022]
Abstract
Oil-based calcium phosphate cement (Paste-CPC) shows not only prolonged shelf life and injection times, but also improved cohesion and reproducibility during application, while retaining the advantages of fast setting, mechanical strength, and biocompatibility. In addition, poly(L-lactide-co-glycolide) (PLGA) fiber reinforcement may decrease the risk for local extrusion. Bone defects (diameter 5 mm; depth 15 mm) generated ex vivo in lumbar (L) spines of female Merino sheep (2–4 years) were augmented using: (i) water-based CPC with 10% PLGA fiber reinforcement (L3); (ii) Paste-CPC (L4); or (iii) clinically established polymethylmethacrylate (PMMA) bone cement (L5). Untouched (L1) and empty vertebrae (L2) served as controls. Cement performance was analyzed using micro-computed tomography, histology, and biomechanical testing. Extrusion was comparable for Paste-CPC(-PLGA) and PMMA, but significantly lower for CPC + PLGA. Compressive strength and Young’s modulus were similar for Paste-CPC and PMMA, but significantly higher compared to those for empty defects and/or CPC + PLGA. Expectedly, all experimental groups showed significantly or numerically lower compressive strength and Young’s modulus than those of untouched controls. Ready-to-use Paste-CPC demonstrates a performance similar to that of PMMA, but improved biomechanics compared to those of water-based CPC + PLGA, expanding the therapeutic arsenal for bone defects. O, significantly lower extrusion of CPC + PLGA fibers into adjacent lumbar spongiosa may help to reduce the risk of local extrusion in spinal surgery.
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Affiliation(s)
- Raimund W. Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Correspondence: ; Tel.: +49-36691-81228
| | - Francesca Gunnella
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Sascha Heinemann
- INNOTERE GmbH, Meissner Str. 191, 01445 Radebeul, Germany; (S.H.); (B.N.)
| | - Berthold Nies
- INNOTERE GmbH, Meissner Str. 191, 01445 Radebeul, Germany; (S.H.); (B.N.)
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
- Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
| | - Bernhard Illerhaus
- BAM Bundesanstalt für Materialforschung und –Prüfung (BAM), 12205 Berlin, Germany;
| | - René Huber
- Institute of Clinical Chemistry, Hannover Medical School, 30625 Hannover, Germany;
| | - Izabela Firkowska-Boden
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
| | - Jörg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
| | - Klaus D. Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, 07743 Jena, Germany; (S.M.); (I.F.-B.); (J.B.); (K.D.J.)
- Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldtstr. 10, 07743 Jena, Germany
- Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, 07743 Jena, Germany
| | - André Sachse
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
| | - Matthias Bungartz
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
| | - Olaf Brinkmann
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany; (F.G.); (E.K.); (V.H.); (A.S.); (M.B.); (O.B.)
- Orthopedic Professorship, Department of Orthopedics, Jena University Hospital, Waldkliniken Eisenberg GmbH, 07607 Eisenberg, Germany
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Taguchi T, Lopez MJ. An overview of de novo bone generation in animal models. J Orthop Res 2021; 39:7-21. [PMID: 32910496 PMCID: PMC7820991 DOI: 10.1002/jor.24852] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 08/27/2020] [Accepted: 09/02/2020] [Indexed: 02/04/2023]
Abstract
Some of the earliest success in de novo tissue generation was in bone tissue, and advances, facilitated by the use of endogenous and exogenous progenitor cells, continue unabated. The concept of one health promotes shared discoveries among medical disciplines to overcome health challenges that afflict numerous species. Carefully selected animal models are vital to development and translation of targeted therapies that improve the health and well-being of humans and animals alike. While inherent differences among species limit direct translation of scientific knowledge between them, rapid progress in ex vivo and in vivo de novo tissue generation is propelling revolutionary innovation to reality among all musculoskeletal specialties. This review contains a comparison of bone deposition among species and descriptions of animal models of bone restoration designed to replicate a multitude of bone injuries and pathology, including impaired osteogenic capacity.
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Affiliation(s)
- Takashi Taguchi
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
| | - Mandi J. Lopez
- Laboratory for Equine and Comparative Orthopedic Research, Department of Veterinary Clinical Sciences, School of Veterinary MedicineLouisiana State UniversityBaton RougeLouisianaUSA
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Rahyussalim AJ, Ivansyah MD, Nugroho A, Wikanjaya R, Canintika AF, Kurniawati T. Vertebral body defects treated with umbilical-cord mesenchymal stem cells combined with hydroxyapatite scaffolds: The first case report. Int J Surg Case Rep 2019; 66:304-308. [PMID: 31901558 PMCID: PMC6940685 DOI: 10.1016/j.ijscr.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Vertebral body defects (VBDs) are one of the most frequent orthopaedic disorders. Such defects often require bone grafts or fusion procedures; however, both procedures often fail due to various factors. Mesenchymal stem cells (MSCs) have been used as a potential therapy to fill bone voids in bone defects, and they may be a potential treatment for VBDs. We reported VBDs treated with MSCs combined with hydroxyapatite scaffolds. PRESENTATION OF CASE A 27-year-old female presented with recurrent back pain. She had a history of decompression and stabilization procedure one year ago after diagnosed with spinal tuberculosis. Initially, she felt back pain that intensifies with activity and relieved with rest. She noticed that the pain begun when once she heard a crack sound on her back while trying to get up from sitting position. There was no history of numbness or tingling sensation. There were no walking problems. Other functions, including micturition and defecation, were within normal limits. The patient firstly underwent lumbotomy procedure, and the images were all confirmed with fluoroscopy X-ray. The vertebrae went debridement, and finally, the bone defect was filled with 20 millions of umbilical cord-mesenchymal stem cells (UC-MSCs) combined with hydroxyapatite in 2 cc of saline. DISCUSSION At three months postoperative, the patient could walk and had no pain. At six months of follow-up, no complications occurred. We also did not see any signs of neoplasm formation, which is consistent with previous studies that used MSCs for orthopaedic treatment. Moreover, no significant bone deformation or spinal cord compression was observed, which suggested the safety of the transplantation procedure. CONCLUSIONS We found that MSCs combined with hydroxyapatite represents a potential therapy for bone regeneration in VBD. Further clinical studies are required to investigate the safety and efficacy of this combination of therapy in VBDs.
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Affiliation(s)
- Ahmad Jabir Rahyussalim
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia; Divion of Spine, Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
| | - Muhammad Deryl Ivansyah
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ahmad Nugroho
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rio Wikanjaya
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Tri Kurniawati
- Stem Cell Integrated Service Unit, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Feng T, Niu J, Pi B, Lu Y, Wang J, Zhang W, Li B, Yang H, Zhu X. Osteogenesis enhancement of silk fibroin/ α-TCP cement by N-acetyl cysteine through Wnt/β-catenin signaling pathway in vivo and vitro. J Mech Behav Biomed Mater 2019; 101:103451. [PMID: 31585350 DOI: 10.1016/j.jmbbm.2019.103451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 06/11/2019] [Accepted: 09/24/2019] [Indexed: 12/18/2022]
Abstract
High brittleness and lack osteogenesis are two major limitations of calcium phosphate cement (CPC) in application in bone defect reconstruction. Here we prepared a composite calcium phosphate cement by mixing N-acetyl cysteine loaded silk fibroin solution with α-tricalcium phosphate. In vitro cytology experiment revealed that SF-NAC/α-TCP could significantly increase the activity of exocrine ALP and up-regulated expression of bone-related genes. However, NAC up-regulated gene expression could be significantly suppressed by DKK1. We propose that NAC functioning as osteogenic factor by activating the Wnt/β-catenin signaling pathway may be the possible mechanism of up-regulation of osteogenic genes. Bone regeneration in vivo shown in a rat femur defect was enhanced by the addition of NAC in SF/α-TCP. In addition, the combination intensity of cement-bone interface was improved. The combination SF-NAC/α-TCP might be developed into a promising tool for bone tissue repair in the clinic.
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Affiliation(s)
- Tao Feng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Junjie Niu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Bin Pi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Yingjie Lu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Jinning Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Wen Zhang
- Orthopedic Institute of Soochow University, Suzhou, 215006, China
| | - Bin Li
- Orthopedic Institute of Soochow University, Suzhou, 215006, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Xuesong Zhu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China.
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Shapiro G, Bez M, Tawackoli W, Gazit Z, Gazit D, Pelled G. Semiautomated Longitudinal Microcomputed Tomography-based Quantitative Structural Analysis of a Nude Rat Osteoporosis-related Vertebral Fracture Model. J Vis Exp 2017. [PMID: 28994771 DOI: 10.3791/55928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Osteoporosis-related vertebral compression fractures (OVCFs) are a common and clinically unmet need with increasing prevalence as the world population ages. Animal OVCF models are essential to the preclinical development of translational tissue engineering strategies. While a number of models currently exist, this protocol describes an optimized method for inducing multiple highly reproducible vertebral defects in a single nude rat. A novel longitudinal semiautomated microcomputed tomography (µCT)-based quantitative structural analysis of the vertebral defects is also detailed. Briefly, rats were imaged at multiple time points post-op. The day 1 scan was reoriented to a standard position, and a standard volume of interest was defined. Subsequent µCT scans of each rat were automatically registered to the day 1 scan so the same volume of interest was then analyzed to assess for new bone formation. This versatile approach can be adapted to a variety of other models where longitudinal imaging-based analysis could benefit from precise 3D semiautomated alignment. Taken together, this protocol describes a readily quantifiable and easily reproducible system for osteoporosis and bone research. The suggested protocol takes 4 months to induce osteoporosis in nude ovariectomized rats and between 2.7 and 4 h to generate, image, and analyze two vertebral defects, depending on tissue size and equipment.
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Affiliation(s)
- Galina Shapiro
- Skeletal Biotech Laboratory, Hebrew University-Hadassah Faculty of Dental Medicine
| | - Maxim Bez
- Skeletal Biotech Laboratory, Hebrew University-Hadassah Faculty of Dental Medicine
| | - Wafa Tawackoli
- Department of Surgery, Cedars-Sinai Medical Center; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center
| | - Zulma Gazit
- Skeletal Biotech Laboratory, Hebrew University-Hadassah Faculty of Dental Medicine; Department of Surgery, Cedars-Sinai Medical Center; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center; Department of Orthopedics, Cedars-Sinai Medical Center
| | - Dan Gazit
- Skeletal Biotech Laboratory, Hebrew University-Hadassah Faculty of Dental Medicine; Department of Surgery, Cedars-Sinai Medical Center; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center; Department of Orthopedics, Cedars-Sinai Medical Center
| | - Gadi Pelled
- Skeletal Biotech Laboratory, Hebrew University-Hadassah Faculty of Dental Medicine; Department of Surgery, Cedars-Sinai Medical Center; Board of Governors Regenerative Medicine Institute, Cedars-Sinai Medical Center; Biomedical Imaging Research Institute, Cedars-Sinai Medical Center;
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Shen GY, Ren H, Tang JJ, Qiu T, Zhang ZD, Zhao WH, Yu X, Huang JJ, Liang D, Yao ZS, Yang ZD, Jiang XB. Effect of osteoporosis induced by ovariectomy on vertebral bone defect/fracture in rat. Oncotarget 2017; 8:73559-73567. [PMID: 29088726 PMCID: PMC5650281 DOI: 10.18632/oncotarget.20611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022] Open
Abstract
Osteoporotic vertebral fracture (OVF) is a worldwide health concern and lacks sufficient basic studies. Suitable animal models should be the foundation for basic study and treatment of OVF. There have been few studies on the development of animal models of osteoporotic vertebral bone defects. OVF models using various animal species should be developed to evaluate the therapeutic strategy in preclinical testing. We developed an OVF model in rats. Rat osteoporosis was induced by ovariectomy (OVX), and 3 months after OVX, a 3 mm diameter hemispheric vertebral bone defect was developed in lumbar vertebra 6 (L6). Sagittal plain X-rays of the rats, their bone quantity, bone microarchitecture, and histomorphology were analyzed: 3 months after OVX, rats showed significantly lower bone quantity, relative bone volume, and total volume bone mineral density. After the vertebral bone defect had developed for 16 weeks, no significant indication of self-healing could be observed from the sagittal plain X-rays, three-dimensional images, and histomorphology. These results indicate that the rat model of osteoporotic vertebral bone defect, induced by OVX and a 3 mm diameter hemispheric vertebral bone defect, can sufficiently mimic OVF patients in clinic and provide a sound basis for subsequent studies.
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Affiliation(s)
- Geng-Yang Shen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Hui Ren
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jing-Jing Tang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ting Qiu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Da Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wen-Hua Zhao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiang Yu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jin-Jing Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhen-Song Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhi-Dong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiao-Bing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,Laboratory Affiliated to National Key Discipline of Orthopaedic and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, China
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Decreased extrusion of calcium phosphate cement versus high viscosity PMMA cement into spongious bone marrow-an ex vivo and in vivo study in sheep vertebrae. Spine J 2016; 16:1468-1477. [PMID: 27496285 DOI: 10.1016/j.spinee.2016.07.529] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 05/28/2016] [Accepted: 07/18/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebroplasty or kyphoplasty of osteoporotic vertebral fractures bears the risk of pulmonary cement embolism (3.5%-23%) caused by leakage of commonly applied acrylic polymethylmethacrylate (PMMA) cement to spongious bone marrow or outside of the vertebrae. Ultraviscous cement and specific augmentation systems have been developed to reduce such adverse effects. Rapidly setting, resorbable, physiological calcium phosphate cement (CPC) may also represent a suitable alternative. PURPOSE This study aimed to compare the intravertebral extrusion of CPC and PMMA cement in an ex vivo and in vivo study in sheep. STUDY DESIGN/SETTING A prospective experimental animal study was carried out. METHODS Defects (diameter 5 mm; 15 mm depth) were created by a ventrolateral percutaneous approach in lumbar vertebrae of female Merino sheep (2-4 years) either ex vivo (n=17) or in vivo (n=6), and injected with: (1) CPC (L3); (2) CPC reinforced with 10% poly(l-lactide-co-glycolide) (PLGA) fibers (L4); or (3) PMMA cement (L5; Kyphon HV-R). Controls were untouched (L1) or empty defects (L2). The effects of the cement injections were assessed in vivo by blood gas analysis and ex vivo by computed tomography (CT), micro-CT (voxel size: 67 µm), histology, and biomechanical testing. RESULTS Following ex vivo injection, micro-CT documented significantly increased extrusion of PMMA cement in comparison to CPC (+/- fibers) starting at a distance of 1 mm from the edge of the defect (confirmed by histology); this was also demonstrated by micro-CT following in vivo cement injection. In addition, blood gas analysis showed consistently significantly lower values for the fraction of oxygenized hemoglobin/total hemoglobin (FO2Hb) in the arterial blood until 25 minutes following injection of the PMMA cement (p ≤ .05 vs. CPC; 7, 15 minutes). Biomechanical testing following ex vivo injection showed significantly lower compressive strength and Young modulus than untouched controls for the empty defect (40% and 34% reduction, respectively) and all three cement-injected defects (21%-27% and 29%-32% reduction, respectively), without significant differences among the cements. CONCLUSIONS Because of comparable compressive strength, but significantly lower cement extrusion into spongious bone marrow than PMMA cement, physiological CPC (+/- PLGA fibers) may represent an attractive alternative to PMMA for vertebroplasty or kyphoplasty of osteoporotic vertebral fractures to reduce the frequency or severity of adverse effects.
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Oliveira MT, Potes J, Queiroga MC, Castro JL, Pereira AF, Rehman S, Dalgarno K, Ramos A, Vitale-Brovarone C, Reis JC. Percutaneous vertebroplasty: a new animal model. Spine J 2016; 16:1253-1262. [PMID: 27374111 DOI: 10.1016/j.spinee.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/25/2016] [Accepted: 06/21/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous vertebroplasty (PVP) is a minimally invasive surgical procedure and is frequently performed in humans who need surgical treatment of vertebral fractures. PVP involves cement injection into the vertebral body, thereby providing rapid and significant pain relief. PURPOSE The testing of novel biomaterials depends on suitable animal models. The aim of this study was to develop a reproducible and safe model of PVP in sheep. STUDY DESIGN This study used ex vivo and in vivo large animal model study (Merino sheep). METHODS Ex vivo vertebroplasty was performed through a bilateral modified parapedicular access in 24 ovine lumbar hemivertebrae, divided into four groups (n=6). Cerament (Bone Support, Lund, Sweden) was the control material. In the experimental group, a novel composite was tested-Spine-Ghost-which consisted of an alpha-calcium sulfate matrix enriched with micrometric particles of mesoporous bioactive glass. All vertebrae were assessed by micro-computed tomography (micro-CT) and underwent mechanical testing. For the in vivo study, 16 sheep were randomly allocated into control and experimental groups (n=8), and underwent PVP using the same bone cements. All vertebrae were assessed postmortem by micro-CT, histology, and reverse transcription-polymerase chain reaction (rt-PCR). This work has been supported by the European Commission under the 7th Framework Programme for collaborative projects (600,000-650,000 USD). RESULTS In the ex vivo model, the average defect volume was 1,275.46±219.29 mm3. Adequate defect filling with cement was observed. No mechanical failure was observed under loads which were higher than physiological. In the in vivo study, cardiorespiratory distress was observed in two animals, and one sheep presented mild neurologic deficits in the hind limbs before recovering. CONCLUSIONS The model of PVP is considered suitable for preclinical in vivo studies, mimicking clinical application. All sheep recovered and completed a 6-month implantation period. There was no evidence of cement leakage into the vertebral foramen in the postmortem examination.
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Affiliation(s)
- Maria Teresa Oliveira
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal.
| | - José Potes
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal
| | - Maria Cristina Queiroga
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Instituto de Ciências Agrárias e Ambientais Mediterrânicas (ICAAM), University of Évora, Apartado 94, 7002-554 Évora, Portugal
| | - José L Castro
- Departamento de Zootecnia, Escola de Ciências e Tecnologia, Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Apartado 94, 7002-554 Évora, Portugal
| | - Alfredo F Pereira
- Departamento de Zootecnia, Escola de Ciências e Tecnologia, Instituto de Ciências Agrárias e Ambientais Mediterrânicas, Apartado 94, 7002-554 Évora, Portugal
| | - Sarrawat Rehman
- JRI Orthopaedics Limited, 18 Churchill Way, Sheffield, S35 2PY, UK
| | - Kenneth Dalgarno
- School of Mechanical and Systems Engineering, Newcastle University, Stephenson Building, Claremont Rd, Newcastle upon Tyne, NE1 7RU, UK
| | - António Ramos
- Biomechanics Research Group, Centre for Mechanical Technology and Automation (TEMA), Department of Mechanical Engineering of the University of Aveiro, Campus Universitário de Santiago, 3810-193, Aveiro, Portugal
| | - Chiara Vitale-Brovarone
- Politecnico di Torino, Corso Duca degli Abruzzi, 24-10129, Torino, Italy; Consorzio per la Ricerca e l'Educazione Permanente (Corep), Sede legale Via Ventimiglia, 115-10126, Torino, Italy
| | - Joana C Reis
- Departamento de Medicina Veterinária (DMV), Escola de Ciências e Tecnologia (ECT), Apartado 94, 7002-554 Évora, Portugal; Complexo de Laboratórios Tecnológicos (CICECO), Campus Universitário de Santiago, 3810-193 Aveiro, Portugal
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Bungartz M, Maenz S, Kunisch E, Horbert V, Xin L, Gunnella F, Mika J, Borowski J, Bischoff S, Schubert H, Sachse A, Illerhaus B, Günster J, Bossert J, Jandt KD, Kinne RW, Brinkmann O. First-time systematic postoperative clinical assessment of a minimally invasive approach for lumbar ventrolateral vertebroplasty in the large animal model sheep. Spine J 2016; 16:1263-1275. [PMID: 27345746 DOI: 10.1016/j.spinee.2016.06.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/20/2016] [Accepted: 06/21/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND CONTEXT Large animal models are highly recommended for meaningful preclinical studies, including the optimization of cement augmentation for vertebral body defects by vertebroplasty/kyphoplasty. PURPOSE The aim of this study was to perform a systematic characterization of a strictly minimally invasive in vivo large animal model for lumbar ventrolateral vertebroplasty. STUDY DESIGN/ SETTING This is a prospective experimental animal study. METHODS Lumbar defects (diameter 5 mm; depth approximately 14 mm) were created by a ventrolateral percutaneous approach in aged, osteopenic, female sheep (40 Merino sheep; 6-9 years; 68-110 kg). L1 remained untouched, L2 was left with an empty defect, and L3 carried a defect injected with a brushite-forming calcium phosphate cement (CPC). Trauma/functional impairment, surgical techniques (including drill sleeve and working canula with stop), reproducibility, bone defects, cement filling, and functional cement augmentation were documented by intraoperative incision-to-suture time and X-ray, postoperative trauma/impairment scores, and ex vivo osteodensitometry, microcomputed tomography (CT), histology, static/fluorescence histomorphometry, and biomechanical testing. RESULTS Minimally invasive vertebroplasty resulted in short operation times (28±2 minutes; mean±standard error of the mean) and X-ray exposure (1.59±0.12 minutes), very limited local trauma (score 0.00±0.00 at 24 hours), short postoperative recovery (2.95±0.29 hours), and rapid decrease of the postoperative impairment score to 0 (3.28±0.36 hours). Reproducible defect creation and cement filling were documented by intraoperative X-ray and ex vivo conventional/micro-CT. Vertebral cement augmentation and osteoconductivity of the CPC was verified by osteodensitometry (CPC>control), micro-CT (CPC>control and empty defect), histology/static histomorphometry (CPC>control and empty defect), fluorescence histomorphometry (CPC>control; all p<.05 for 3 and 9 months), and compressive strength measurements (CPC numerically higher than control; 102% for 3 months and 110% for 9 months). CONCLUSIONS This first-time systematic clinical assessment of a minimally invasive, ventrolateral, lumbar vertebroplasty model in aged, osteopenic sheep resulted in short operation times, rapid postoperative recovery, and high experimental reproducibility. This model represents an optimal basis for standardized evaluation of future studies on vertebral augmentation with resorbable and osteoconductive CPC.
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Affiliation(s)
- Matthias Bungartz
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle," Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany; Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany.
| | - Stefan Maenz
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, D-07743 Jena, Germany; Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, D-07743 Jena, Germany
| | - Elke Kunisch
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Victoria Horbert
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Long Xin
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Francesca Gunnella
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Joerg Mika
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Juliane Borowski
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Sabine Bischoff
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Dornburger Str. 23, D-07743 Jena, Germany
| | - Harald Schubert
- Institute of Laboratory Animal Sciences and Welfare, Jena University Hospital, Dornburger Str. 23, D-07743 Jena, Germany
| | - Andre Sachse
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle," Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Bernhard Illerhaus
- BAM Bundesanstalt für Materialforschung und - prüfung (BAM), Unter den Eichen 87, D-12205 Berlin, Germany
| | - Jens Günster
- BAM Bundesanstalt für Materialforschung und - prüfung (BAM), Unter den Eichen 87, D-12205 Berlin, Germany
| | - Jörg Bossert
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, D-07743 Jena, Germany
| | - Klaus D Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research, Friedrich Schiller University Jena, Löbdergraben 32, D-07743 Jena, Germany; Jena School for Microbial Communication (JSMC), Friedrich Schiller University Jena, Neugasse 23, D-07743 Jena, Germany; Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, Humboldstr. 10, D-07743 Jena, Germany
| | - Raimund W Kinne
- Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
| | - Olaf Brinkmann
- Chair of Orthopedics, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle," Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany; Experimental Rheumatology Unit, Department of Orthopedics, Jena University Hospital, Waldkrankenhaus "Rudolf Elle", Klosterlausnitzer Str 81, D-07607 Eisenberg, Germany
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Cementless Titanium Mesh Fixation of Osteoporotic Burst Fractures of the Lumbar Spine Leads to Bony Healing: Results of an Experimental Sheep Model. BIOMED RESEARCH INTERNATIONAL 2016; 2016:4094161. [PMID: 27019848 PMCID: PMC4785241 DOI: 10.1155/2016/4094161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/04/2016] [Indexed: 01/12/2023]
Abstract
Introduction. Current treatment strategies for osteoporotic vertebral compression fractures (VCFs) focus on cement-associated solutions. Complications associated with cement application are leakage, embolism, adjacent fractures, and compromise in bony healing. This study comprises a validated VCF model in osteoporotic sheep in order to (1) evaluate a new cementless fracture fixation technique using titanium mesh implants (TMIs) and (2) demonstrate the healing capabilities in osteoporotic VCFs. Methods. Twelve 5-year-old Merino sheep received ovariectomy, corticosteroid injections, and a calcium/phosphorus/vitamin D-deficient diet for osteoporosis induction. Standardized VCFs (type AO A3.1) were created, reduced, and fixed using intravertebral TMIs. Randomly additional autologous spongiosa grafting (G1) or no augmentation was performed (G2, n = 6 each). Two months postoperatively, macroscopic, micro-CT and biomechanical evaluation assessed bony consolidation. Results. Fracture reduction succeeded in all cases without intraoperative complications. Bony consolidation was proven for all cases with increased amounts of callus development for G2 (58.3%). Micro-CT revealed cage integration. Neither group showed improved results with biomechanical testing. Conclusions. Fracture reduction/fixation using TMIs without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing. Intravertebral application of autologous spongiosa showed no beneficial effects. The technique is now available for clinical use; thus, it offers an opportunity to abandon cement-associated complications.
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Muto M, Guarnieri G, Giurazza F, Manfrè L. What's new in vertebral cementoplasty? Br J Radiol 2016; 89:20150337. [PMID: 26728798 DOI: 10.1259/bjr.20150337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Vertebral cementoplasty is a well-known mini-invasive treatment to obtain pain relief in patients affected by vertebral porotic fractures, primary or secondary spine lesions and spine trauma through intrametameric cement injection. Two major categories of treatment are included within the term vertebral cementoplasty: the first is vertebroplasty in which a simple cement injection in the vertebral body is performed; the second is assisted technique in which a device is positioned inside the metamer before the cement injection to restore vertebral height and allow a better cement distribution, reducing the kyphotic deformity of the spine, trying to obtain an almost normal spine biomechanics. We will describe the most advanced techniques and indications of vertebral cementoplasty, having recently expanded the field of applications to not only patients with porotic fractures but also spine tumours and trauma.
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Affiliation(s)
- Mario Muto
- 1 Neuroradiology Department, Cardarelli Hospital, Naples, Italy
| | | | - Francesco Giurazza
- 2 Radiology Department-Università Campus Bio-Medico di Roma, Rome, Italy
| | - Luigi Manfrè
- 3 Minimal Invasive Spine Department-AOEC "Cannizzaro", Catania, Italy
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PTH Induces Systemically Administered Mesenchymal Stem Cells to Migrate to and Regenerate Spine Injuries. Mol Ther 2015; 24:318-330. [PMID: 26585691 DOI: 10.1038/mt.2015.211] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 11/13/2015] [Indexed: 12/11/2022] Open
Abstract
Osteoporosis affects more than 200 million people worldwide leading to more than 2 million fractures in the United States alone. Unfortunately, surgical treatment is limited in patients with low bone mass. Parathyroid hormone (PTH) was shown to induce fracture repair in animals by activating mesenchymal stem cells (MSCs). However, it would be less effective in patients with fewer and/or dysfunctional MSCs due to aging and comorbidities. To address this, we evaluated the efficacy of combination i.v. MSC and PTH therapy versus monotherapy and untreated controls, in a rat model of osteoporotic vertebral bone defects. The results demonstrated that combination therapy significantly increased new bone formation versus monotherapies and no treatment by 2 weeks (P < 0.05). Mechanistically, we found that PTH significantly enhanced MSC migration to the lumbar region, where the MSCs differentiated into bone-forming cells. Finally, we used allogeneic porcine MSCs and observed similar findings in a clinically relevant minipig model of vertebral defects. Collectively, these results demonstrate that in addition to its anabolic effects, PTH functions as an adjuvant to i.v. MSC therapy by enhancing migration to heal bone loss. This systemic approach could be attractive for various fragility fractures, especially using allogeneic cells that do not require invasive tissue harvest.
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Abstract
Bone defects do not heal in 5-10% of the fractures. In order to enhance bone regeneration, drug delivery systems are needed. They comprise a scaffold with or without inducing factors and/or cells. To test these drug delivery systems before application in patients, they finally need to be tested in animal models. The choice of animal model depends on the main research question; is a functional or mechanistic evaluation needed? Furthermore, which type of bone defects are investigated: load-bearing (i.e. orthopedic) or non-load-bearing (i.e. craniomaxillofacial)? This determines the type of model and in which type of animal. The experiments need to be set-up using the 3R principle and must be reported following the ARRIVE guidelines.
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No YJ, Roohani-Esfahani SI, Zreiqat H. Nanomaterials: the next step in injectable bone cements. Nanomedicine (Lond) 2015; 9:1745-64. [PMID: 25321173 DOI: 10.2217/nnm.14.109] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Injectable bone cements (IBCs) are biocompatible materials that can be used as bone defect fillers in maxillofacial surgeries and in orthopedic fracture treatment in order to augment weakened bone due to osteoporosis. Current clinically available IBCs, such as polymethylmethacrylate and calcium phosphate cement, have certain advantages; however, they possess several drawbacks that prevent them from gaining universal acceptance. New gel-based injectable materials have also been developed, but these are too mechanically weak for load-bearing applications. Recent research has focused on improving various injectable materials using nanomaterials in order to render them suitable for bone tissue regeneration. This article outlines the requirements of IBCs, the advantages and limitations of currently available IBCs and the state-of-the-art developments that have demonstrated the effects of nanomaterials within injectable systems.
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Affiliation(s)
- Young Jung No
- Biomaterials & Tissue Engineering Research Unit, School of AMME, The University of Sydney, Sydney 2006, Australia
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Li Y, Chen SK, Li L, Qin L, Wang XL, Lai YX. Bone defect animal models for testing efficacy of bone substitute biomaterials. J Orthop Translat 2015; 3:95-104. [PMID: 30035046 PMCID: PMC5982383 DOI: 10.1016/j.jot.2015.05.002] [Citation(s) in RCA: 207] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 05/21/2015] [Accepted: 05/21/2015] [Indexed: 12/25/2022] Open
Abstract
Large bone defects are serious complications that are most commonly caused by extensive trauma, tumour, infection, or congenital musculoskeletal disorders. If nonunion occurs, implantation for repairing bone defects with biomaterials developed as a defect filler, which can promote bone regeneration, is essential. In order to evaluate biomaterials to be developed as bone substitutes for bone defect repair, it is essential to establish clinically relevant in vitro and in vivo testing models for investigating their biocompatibility, mechanical properties, degradation, and interactional with culture medium or host tissues. The results of the in vitro experiment contribute significantly to the evaluation of direct cell response to the substitute biomaterial, and the in vivo tests constitute a step midway between in vitro tests and human clinical trials. Therefore, it is essential to develop or adopt a suitable in vivo bone defect animal model for testing bone substitutes for defect repair. This review aimed at introducing and discussing the most available and commonly used bone defect animal models for testing specific substitute biomaterials. Additionally, we reviewed surgical protocols for establishing relevant preclinical bone defect models with various animal species and the evaluation methodologies of the bone regeneration process after the implantation of bone substitute biomaterials. This review provides an important reference for preclinical studies in translational orthopaedics.
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Affiliation(s)
- Ye Li
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Shu-Kui Chen
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Long Li
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Ling Qin
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xin-Luan Wang
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Xiao Lai
- Centre for Translational Medicine Research and Development, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,State Key Laboratory of Molecular Engineering of Polymers, Fudan University, Shanghai, China
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Klíma K, Vaněček V, Kohout A, Jiroušek O, Foltán R, Štulík J, Machoň V, Pavlíková G, Jendelová P, Syková E, Šedý J. Stem cells regenerative properties on new rat spinal fusion model. Physiol Res 2014; 64:119-28. [PMID: 25194134 DOI: 10.33549/physiolres.932728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Stem cells biology is one of the most frequent topic of physiological research of today. Spinal fusion represents common bone biology challenge. It is the indicator of osteoinduction and new bone formation on ectopic model. The purpose of this study was to establish a simple model of spinal fusion based on a rat model including verification of the possible use of titanium microplates with hydroxyapatite scaffold combined with human bone marrow-derived mesenchymal stem cells (MSCs). Spinous processes of two adjacent vertebrae were fixed in 15 Wistar rats. The space between bony vertebral arches and spinous processes was either filled with augmentation material only and covered with a resorbable collagen membrane (Group 1), or filled with augmentation material loaded with 5 × 10⁶ MSCs and covered with a resorbable collagen membrane (Group 2). The rats were sacrificed 8 weeks after the surgery. Histology, histomorphometry and micro-CT were performed. The new model of interspinous fusion was safe, easy, inexpensive, with zero mortality. We did not detect any substantial pathological changes or tumor formation after graft implantation. We observed a nonsignificant effect on the formation of new bone tissue between Group 1 and Group 2. In the group with MSCs (Group 2) we described minor inflamatory response which indicates the imunomodulational and antiinflamatory role of MSCs. In conclusion, this new model proved to be easy to use in small animals like rats.
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Affiliation(s)
- K Klíma
- Department of Oral and Maxillofacial Surgery, General University Hospital, Prague, Czech Republic, Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic.
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Vaněček V, Klíma K, Kohout A, Foltán R, Jiroušek O, Šedý J, Štulík J, Syková E, Jendelová P. The combination of mesenchymal stem cells and a bone scaffold in the treatment of vertebral body defects. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 22:2777-86. [PMID: 24013719 DOI: 10.1007/s00586-013-2991-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 08/26/2013] [Accepted: 08/29/2013] [Indexed: 01/23/2023]
Abstract
PURPOSE Vertebral body defects represent one of the most common orthopedic challenges. In order to advance the transfer of stem cell therapies into orthopedic clinical practice, we performed this study to evaluate the safety and efficacy of a composite bioartificial graft based on a hydroxyapatite bone scaffold (CEM-OSTETIC(®)) combined with human mesenchymal stem cells (MSCs) in a rat model of vertebral body defects. METHODS Under general isoflurane anesthesia, a defect in the body of the L2 vertebra was prepared and left to heal spontaneously (group 1), implanted with scaffold material alone (group 2), or implanted with a scaffold together with 0.5 million MSCs (group 3) or 5 million MSCs (group 4). The rats were killed 8 weeks after surgery. Histological and histomorphometrical evaluation of the implant as well as micro-CT imaging of the vertebrae were performed. RESULTS We observed a significant effect on the formation of new bone tissue in the defect in group 4 when compared to the other groups and a reduced inflammatory reaction in both groups receiving a scaffold and MSCs. We did not detect any substantial pathological changes or tumor formation after graft implantation. CONCLUSIONS MSCs in combination with a hydroxyapatite scaffold improved the repair of a model bone defect and might represent a safe and effective alternative in the treatment of vertebral bone defects.
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Affiliation(s)
- Václav Vaněček
- Institute of Experimental Medicine, Academy of Sciences of the Czech Republic (ASCR), Vídeňská 1083, 142 20, Prague 4, Czech Republic
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Klein K, Zamparo E, Kronen PW, Kämpf K, Makara M, Steffen T, von Rechenberg B. Bone augmentation for cancellous bone- development of a new animal model. BMC Musculoskelet Disord 2013; 14:200. [PMID: 23819858 PMCID: PMC3706338 DOI: 10.1186/1471-2474-14-200] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 06/19/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reproducible and suitable animal models are required for in vivo experiments to investigate new biodegradable and osteoinductive biomaterials for augmentation of bones at risk for osteoporotic fractures. Sheep have especially been used as a model for the human spine due to their size and similar bone metabolism. However, although sheep and human vertebral bodies have similar biomechanical characteristics, the shape of the vertebral bodies, the size of the transverse processes, and the different orientation of the facet joints of sheep are quite different from those of humans making the surgical approach complicated and unpredictable. Therefore, an adequate and safe animal model for bone augmentation was developed using a standardized femoral and tibia augmentation site in sheep. METHODS The cancellous bone of the distal femur and proximal tibia were chosen as injection sites with the surgical approach via the medial aspects of the femoral condyle and proximal tibia metaphysis (n = 4 injection sites). For reproducible drilling and injection in a given direction and length, a custom-made c-shaped aiming device was designed. Exact positioning of the aiming device and needle positioning within the intertrabecular space of the intact bone could be validated in a predictable and standardized fashion using fluoroscopy. After sacrifice, bone cylinders (Ø 32 mm) were harvested throughout the tibia and femur by means of a diamond-coated core drill, which was especially developed to harvest the injected bone area exactly. Thereafter, the extracted bone cylinders were processed as non-decalcified specimens for μCT analysis, histomorphometry, histology, and fluorescence evaluation. RESULTS The aiming device could be easily placed in 63 sheep and assured a reproducible, standardized injection area. In four sheep, cardiovascular complications occurred during surgery and pulmonary embolism was detected by computed tomography post surgery in all of these animals. The harvesting and evaluative methods assured a standardized analysis of all samples. CONCLUSIONS This experimental animal model provides an excellent basis for testing new biomaterials for their suitability as bone augmentation materials. Concomitantly, similar cardiovascular changes occur during vertebroplasties as in humans, thus making it a suitable animal model for studies related to vertebroplasty.
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Affiliation(s)
- Karina Klein
- Musculoskeletal Research Unit (MSRU), Equine Department, University of Zurich, Winterthurerstrasse 260, Zurich CH-8057, Switzerland.
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Evaluation of calcium phosphate and calcium sulfate as injectable bone cements in sheep vertebrae. ACTA ACUST UNITED AC 2013; 25:333-7. [PMID: 21666507 DOI: 10.1097/bsd.0b013e3182213f57] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN An animal study. OBJECTIVE To compare the biomechanical and biometabolic properties between calcium phosphate (CaP), calcium sulfate (CaS), and polymethylmethacrylate (PMMA) as bone void fillers in a sheep model of lumbar vertebral defect. SUMMARY OF BACKGROUND DATA PMMA is commonly used as a bone void filler in vertebroplasty and kyphoplasty. However, it has certain intrinsic limitations. CaP and CaS are considered as potential PMMA substitutes, but further in vivo evaluations of their biomechanical and biometabolic properties are needed before they can be recommended for clinical use in routine vertebroplasty and kyphoplasty procedures. METHODS Bone voids were experimentally created on lumbar vertebrae L2-L5 with L6 left intact as a normal control in 24 adult female sheep. The defect vertebrae L2-L5 in each of the animals were randomized to receive no filler augmentation (controls) or augmentation with CaP, CaS, or PMMA. Animals were killed after 2, 12, and 24 weeks of the bone filler augmentation, respectively. Vertebrae L2-L6 were collected and their biomechanical strength/stiffness, osseointegration activity, and biodegradability were evaluated. RESULTS At all 3 time points tested, the PMMA-augmented lumbar vertebra had the highest biomechanical strength and stiffness, followed by the intact vertebra L6. CaP and CaS significantly improved the strength as compared with the sham augmentation, but did not yet restore it to the normal level. Osteogenesis occurred at low levels in the empty vertebrae, in the CaP-augmented defect vertebrae at 12 and 24 weeks, and in the CaS-augmented vertebrae at 12 weeks, but at a substantially high level after 24 weeks of CaS augmentation. The filler biodegradation rate was low in the CaP-augmented vertebrae, but was substantially high in the CaS-augmented vertebrae. CONCLUSIONS CaP and CaS are effective enough to strengthen the fractured lumbar vertebrae in a time-dependent manner, although not as good as PMMA. CaS has a much higher osseointegration capacity than CaP.
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Bongio M, van den Beucken JJJP, Leeuwenburgh SCG, Jansen JA. Preclinical evaluation of injectable bone substitute materials. J Tissue Eng Regen Med 2012; 9:191-209. [DOI: 10.1002/term.1637] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Revised: 07/25/2012] [Accepted: 09/27/2012] [Indexed: 12/15/2022]
Affiliation(s)
- Matilde Bongio
- Department of Biomaterials; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
| | | | | | - John A. Jansen
- Department of Biomaterials; Radboud University Nijmegen Medical Centre; Nijmegen The Netherlands
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Marcia S, Boi C, Dragani M, Marini S, Marras M, Piras E, Anselmetti GC, Masala S. Effectiveness of a bone substitute (CERAMENT™) as an alternative to PMMA in percutaneous vertebroplasty: 1-year follow-up on clinical outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 21 Suppl 1:S112-8. [PMID: 22434530 PMCID: PMC3325384 DOI: 10.1007/s00586-012-2228-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 02/19/2012] [Indexed: 12/31/2022]
Abstract
PURPOSE The aim of the study was to evaluate the efficacy of an injectable and partly absorbable calcium bone cement (CERAMENT™, Bone Support, Sweden) in the treatment of osteoporotic or traumatic vertebral fractures by percutaneous vertebroplasty. METHODS From March 2009 to October 2010 an open, prospective study in two centres was performed. 33 patients with symptomatic vertebral fractures were enrolled. Patients were included based on evaluation by X-ray, CT, and MRI. Clinical evaluation by Visual Analogue Scale (VAS, 0-10) and Oswestry Disability index test (ODI, 0-100 %) was performed before the operation as well as 1, 6 and 12 months after the procedure. Radiology assessment post-procedure was carried out by X-ray, CT, and MRI at 1, 6 and 12 months post-op. Intake of analgesic medications pre- and post-procedure was monitored. RESULTS 66 vertebral bodies underwent percutaneous vertebroplasty. VAS score demonstrated a significant decrease from 8.61 (SD 19.8) pre-operatively to 2.48 (SD 2.36) at 1 month. The score was 2.76 (SD 2.68) at 6 months and 1.36 (SD 1.33) at the latest follow up. ODI score dropped significantly from 58.86 pre-op to 26.94 at 6 months and further down to 7.61 at 12 months. No re-fractures or adjacent level fractures were reported. CONCLUSION Data show that CERAMENT can be a substitute of PMMA in the treatment of osteoporotic and traumatic vertebral fractures, especially in young patients.
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Affiliation(s)
- Stefano Marcia
- Department of Diagnostic and Interventional Radiology, S. Giovanni di Dio Hospital, Cagliari University, Cagliari, Italy
| | - Claudia Boi
- Department of Diagnostic and Interventional Radiology, S. Giovanni di Dio Hospital, Cagliari University, Cagliari, Italy
| | - Mario Dragani
- Radiology Institute, Pescara Hospital, Pescara, Italy
| | - Stefano Marini
- Department of Diagnostic and Interventional Radiology, S. Giovanni di Dio Hospital, Cagliari University, Cagliari, Italy
| | - Mariangela Marras
- Department of Diagnostic and Interventional Radiology, S. Giovanni di Dio Hospital, Cagliari University, Cagliari, Italy
| | - Emanuele Piras
- Department of Diagnostic and Interventional Radiology, S. Giovanni di Dio Hospital, Cagliari University, Cagliari, Italy
| | | | - Salvatore Masala
- Department of Diagnostic and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy
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