1
|
Xie S, Cui L, Wang C, Liu H, Ye Y, Gong S, Li J. Contact between leaked cement and adjacent vertebral endplate induces a greater risk of adjacent vertebral fracture with vertebral bone cement augmentation biomechanically. Spine J 2024:S1529-9430(24)01034-9. [PMID: 39343240 DOI: 10.1016/j.spinee.2024.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 08/13/2024] [Accepted: 09/14/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND CONTEXT Adjacent vertebral fracture (AVF) is a frequently observed complication after percutaneous vertebroplasty in patients with osteoporotic vertebral compressive fracture (OVCF). Studies have demonstrated that intervertebral cement leakage (ICL) can increase the incidence of AVF, but others have reached opposite conclusions. The stress concentration initially increases the risk of AVF, and dispersive concentrated stress is the main biomechanical function of the intervertebral disc (IVD). PURPOSE This study was designed to validate the hypothesis that direct contact between the leaked cement and adjacent bony endplate (BEP) can inhibit this biomechanical function, trigger adjacent vertebral stress concentration and increase the risk of AVF. STUDY DESIGN A retrospective study and corresponding numerical mechanical simulations. PATIENT SAMPLE Clinical data from 97 OVCF patients treated by bone cement augmentation operations were reviewed in this study. OUTCOME MEASURES Clinical assessments involved measuring ICL and cement-BEP contact status in patients with and without AVF. Numerical simulations were conducted to compute stress values in adjacent vertebral body's BEP and cancellous bone under various body positions. MATERIALS AND METHODS Radiographic and demographic data of 97 OVCF patients (with an average follow-up period of 11.5 months) treated using bone cement augmentation operation were reviewed in the present study. The patients were divided into two groups: those with AVF and those without AVF. Bone cement leakage status was judged via two different methods: with or without IVD cement leakage and with and without adjacent vertebral endplate contact. The data from patients with and without AVF were compared, and the independent risk factors were identified through regression analysis. Patients without IVD cement leakage, with IVD cement leakage but without adjacent vertebral endplate cement contact, and with direct adjacent vertebral endplate cement contact were simulated using a previously constructed and validated lumbar finite element model, and the biomechanical indicators related to the AVF were computed and recorded in these surgical models. RESULTS Radiographic analysis revealed that the incidence of AVF was numerically higher, but was not significantly higher in patients with IVD cement leakage. In contrast, patients with direct adjacent vertebral endplate cement contact had a significantly greater incidence of AVF, which has also been proven to be an independent risk factor for AVF. In addition, numerical mechanical simulations revealed an obvious stress concentration tendency (the higher maximum equivalent stress value) in the adjacent vertebral body in the model with endplate cement contact. CONCLUSION Direct adjacent vertebral endplate cement contact induces a greater risk of AVF through deterioration of the local biomechanical environment. Cement injection, therefore, should be terminated when IVD cement leakage occurs to reduce adjacent vertebral endplate cement contact and reduce the resulting risk of AVF biomechanics.
Collapse
Affiliation(s)
- Shiming Xie
- Department of Spine surgery, Mianyang Orthopedic Hospital, Mianyang, 621052, Sichuan Province, P.R. China
| | - Liqiang Cui
- Department of Spine surgery, Mianyang Orthopedic Hospital, Mianyang, 621052, Sichuan Province, P.R. China
| | - Chenglong Wang
- Department of Spine surgery, Mianyang Orthopedic Hospital, Mianyang, 621052, Sichuan Province, P.R. China
| | - Hongjun Liu
- Department of Spine surgery, Mianyang Orthopedic Hospital, Mianyang, 621052, Sichuan Province, P.R. China
| | - Yu Ye
- Department of Spine surgery, Mianyang Orthopedic Hospital, Mianyang, 621052, Sichuan Province, P.R. China
| | - Shuangquan Gong
- Department of Spine surgery, Mianyang Orthopedic Hospital, Mianyang, 621052, Sichuan Province, P.R. China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, 646000, Sichuan Province, PR China.
| |
Collapse
|
2
|
Chen J, Lu S, Chen Y, Zhang X, Xi Z, Xie L, Li J. Space between bone cement and bony endplate can trigger higher incidence of augmented vertebral collapse: An in-silico study. J Clin Neurosci 2024; 125:152-158. [PMID: 38815301 DOI: 10.1016/j.jocn.2024.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The pathogenesis of postoperative complications in patients with osteoporotic vertebral compressive fractures (OVCFs) undergoing percutaneous vertebroplasty (PVP) is multifaceted, with local biomechanical deterioration playing a pivotal role. Specifically, the disparity in stiffness between the bone cement and osteoporotic cancellous bone can precipitate interfacial stress concentrations, potentially leading to cement-augmented vertebral body collapse and clinical symptom recurrence. This study focuses on the biomechanical implications of the space between the bone cement and bony endplate (BEP), hypothesizing that this interface may be a critical locus for stress concentration and subsequent vertebral failure. METHODS Leveraging a validated numerical model from our previous study, we examined the biomechanical impact of the cement-BEP interface in the L2 vertebral body post-PVP, simulated OVCF and PVP and constructed three distinct models: one with direct bone cement contact with both cranial and caudal BEPs, one with contact only with the caudal BEPs and one without contact with either BEP. Moreover, we assessed stress distribution across cranial and caudal BEPs under various loading conditions to describe the biomechanical outcomes associated with each model. RESULTS A consistent trend was observed across all models: the interfaces between the bone cement and cancellous bone exhibited higher stress values under the majority of loading conditions compared to models with direct cement-BEP contact. The most significant difference was observed in the flexion loading condition compared to the mode with direct contact between BEP and cement. The maximum stress in models without direct contact increased by at least 30%. CONCLUSIONS Our study reveals the biomechanical significance of interfacial stiffness differences at the cement-BEP junction, which can exacerbate local stress concentrations and predispose to augmented vertebral collapse. We recommend the strategic distribution of bone cement to encompass a broader contact area with the BEP for preventing biomechanical failure and subsequent vertebral collapse.
Collapse
Affiliation(s)
- Ji Chen
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu Province, PR China; Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine Kunshan, Soochow 215300, Jiangsu Province, PR China
| | - Shihao Lu
- Naval Medical University, Xiangyin Road, Shanghai 200433, PR China
| | - Yong Chen
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine Kunshan, Soochow 215300, Jiangsu Province, PR China
| | - Xiang Zhang
- Orthopedic Center, Kunshan Hospital of Traditional Chinese Medicine Kunshan, Soochow 215300, Jiangsu Province, PR China
| | - Zhipeng Xi
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu Province, PR China
| | - Lin Xie
- Department of Orthopedics, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Third Clinical Medical College, Nanjing University of Chinese Medicine, Nanjing 210028, Jiangsu Province, PR China.
| | - Jingchi Li
- Department of Orthopedics, Luzhou Key Laboratory of Orthopedic Disorders, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, NO.182, Chunhui Road, Longmatan District, Luzhou, Sichuan Province, PR China.
| |
Collapse
|
3
|
Zhou C, Meng X, Huang S, Chen H, Zhou H, Liao Y, Tang Z, Zhang X, Li H, Sun W, Wang Y. Biomechanical study of different bone cement distribution on osteoporotic vertebral compression Fracture-A finite element analysis. Heliyon 2024; 10:e26726. [PMID: 38434291 PMCID: PMC10907677 DOI: 10.1016/j.heliyon.2024.e26726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 02/18/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Purpose This study aimed to compare the biomechanical effects of different bone cement distribution methods on osteoporotic vertebral compression fractures (OVCF). Patients and methods Raw CT data from a healthy male volunteer was used to create a finite element model of the T12-L2 vertebra using finite element software. A compression fracture was simulated in the L1 vertebra, and two forms of bone cement dispersion (integration group, IG, and separation group, SG) were also simulated. Six types of loading (flexion, extension, left/right bending, and left/right rotation) were applied to the models, and the stress distribution in the vertebra and intervertebral discs was observed. Additionally, the maximum displacement of the L1 vertebra was evaluated. Results Bone cement injection significantly reduced stress following L1 vertebral fractures. In the L1 vertebral body, the maximum stress of SG was lower than that of IG during flexion, left/right bending, and left/right rotation. In the T12 vertebral body, compared with IG, the maximum stress of SG decreased during flexion and right rotation. In the L2 vertebral body, the maximum stress of SG was the lowest under all loading conditions. In the T12-L1 intervertebral disc, compared with IG, the maximum stress of SG decreased during flexion, extension, and left/right bending and was basically the same during left/right rotation. However, in the L1-L2 intervertebral discs, the maximum stress of SG increased during left/right rotation compared with that of IG. Furthermore, the maximum displacement of SG was smaller than that of IG in the L1 vertebral bodies under all loading conditions. Conclusions SG can reduce the maximum stress in the vertebra and intervertebral discs, offering better biomechanical performance and improved stability than IG.
Collapse
Affiliation(s)
- Chengqiang Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xiao Meng
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shaolong Huang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Han Chen
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Haibin Zhou
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yifeng Liao
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Zhongjian Tang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xu Zhang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
- Graduate School of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hua Li
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wei Sun
- Department of Spine Surgery, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yunqing Wang
- Department of Spine Surgery, The Second Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| |
Collapse
|
4
|
Xu H, Feng Q, Ma X, Lan J, Ji J, Zhang Z, Miao J. Biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease: a finite element study. BMC Musculoskelet Disord 2023; 24:967. [PMID: 38098003 PMCID: PMC10720208 DOI: 10.1186/s12891-023-07090-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/02/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE To investigate and evaluate the biomechanical behaviour of a novel bone cement screw in the minimally invasive treatment of Kummell's disease (KD) by finite element (FE) analysis. METHODS A validated finite element model of healthy adult thoracolumbar vertebrae T12-L2 was given the osteoporotic material properties and the part of the middle bone tissue of the L1 vertebral body was removed to make it wedge-shaped. Based on these, FE model of KD was established. The FE model of KD was repaired and treated with three options: pure percutaneous vertebroplasty (Model A), novel unilateral cement screw placement (Model B), novel bilateral cement screw placement (Model C). Range of motion (ROM), maximum Von-Mises stress of T12 inferior endplate and bone cement, relative displacement of bone cement, and stress distribution of bone cement screws of three postoperative models and intact model in flexion and extension, as well as lateral bending and rotation were analyzed and compared. RESULTS The relative displacements of bone cement of Model B and C were similar in all actions studied, and both were smaller than that of Model A. The minimum value of relative displacement of bone cement is 0.0733 mm in the right axial rotation of Model B. The maximum Von-Mises stress in T12 lower endplate and bone cement was in Model C. The maximum Von-Mises stress of bone cement screws in Model C was less than that in Model B, and it was the most substantial in right axial rotation, which is 34%. There was no substantial difference in ROM of the three models. CONCLUSION The novel bone cement screw can effectively reduce the relative displacement of bone cement by improving the stability of local cement. Among them, novel unilateral cement screw placement can obtain better fixation effect, and the impact on the biomechanical environment of vertebral body is less than that of novel bilateral cement screw placement, which provides a reference for minimally invasive treatment of KD in clinical practice.
Collapse
Affiliation(s)
- Hanpeng Xu
- Tianjin Hospital, Tianjin University, Tianjin, China
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Feng
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xiang Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jie Lan
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jingtao Ji
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Zepei Zhang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jun Miao
- Tianjin Hospital, Tianjin University, Tianjin, China.
| |
Collapse
|
5
|
Dai H, Liu Y, Han Q, Zhang A, Chen H, Qu Y, Wang J, Zhao J. Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis. Front Bioeng Biotechnol 2022; 10:978917. [PMID: 36159704 PMCID: PMC9495612 DOI: 10.3389/fbioe.2022.978917] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 08/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objective: The osteoporotic vertebral compression fracture (OVCF) has an incidence of 7.8/1000 person-years at 55–65 years. At 75 years or older, the incidence increases to 19.6/1000 person-years in females and 5.2–9.3/1000 person-years in males. To solve this problem, percutaneous vertebroplasty (PVP) was developed in recent years and has been widely used in clinical practice to treat OVCF. Are the clinical effects of unilateral percutaneous vertebroplasty (UPVP) and bilateral percutaneous vertebroplasty (BPVP) the same? The purpose of this study was to compare biomechanical differences between UPVP and BPVP using finite element analysis. Materials and methods: The heterogeneous assignment finite element (FE) model of T11-L1 was constructed and validated. A compression fracture of the vertebral body was performed at T12. UPVP and BPVP were simulated by the difference in the distribution of bone cement in T12. Stress distributions and maximum von Mises stresses of vertebrae and intervertebral discs were compared. The rate of change of maximum displacement between UPVP and BPVP was evaluated. Results: There were no obvious high-stress concentration regions on the anterior and middle columns of the T12 vertebral body in BPVP. Compared with UPVP, the maximum stress on T11 in BPVP was lower under left/right lateral bending, and the maximum stress on L1 was lower under all loading conditions. For the T12-L1 intervertebral disc, the maximum stress of BPVP was less than that of UPVP. The maximum displacement of T12 after BPVP was less than that after UPVP under the six loading conditions. Conclusion: BPVP could balance the stress of the vertebral body, reduce the maximum stress of the intervertebral disc, and offer advantages in terms of stability compared with UPVP. In summary, BPVP could reduce the incidence of postoperative complications and provide promising clinical effects for patients.
Collapse
Affiliation(s)
| | | | | | | | | | - Yang Qu
- *Correspondence: Yang Qu, ; Jincheng Wang,
| | | | | |
Collapse
|
6
|
Yang B, Zhao Y, Zhao Y. Is the incidence of sandwich vertebral fracture higher than that of ordinary adjacent vertebral fracture after PKP? Medicine (Baltimore) 2022; 101:e29900. [PMID: 35801767 PMCID: PMC9259101 DOI: 10.1097/md.0000000000029900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE To compare the incidence of fracture between sandwich vertebra and ordinary adjacent vertebra after percutaneous kyphoplasty (PKP). METHOD We analyzed 225 consecutive patients with osteoporotic vertebral compression fractures who underwent PKP between January 2016 and December 2020 at our medical institution. The sandwich vertebrae was located between 2 cement-augmented vertebra and was followed for at least 12 months. The clinical data of patients with sandwich vertebra and ordinary adjacent vertebra were recorded, and the incidence of postoperative fracture between sandwich vertebra and ordinary adjacent vertebra was compared. RESULTS The mean continuous follow-up time was 31.30 ± 18.04 months in patients with sandwich vertebra and 25.85 ± 7.96 months in patients with ordinary adjacent vertebra. It should be noted that the incidence of sandwich vertebral fractures was 10.00%, which was not statistically higher than 3.26% for ordinary adjacent vertebral fractures. However, a significant difference was observed in the cement volume of single vertebral body, procedure time, and bleeding. CONCLUSION Although the volume of cement in a single vertebral body is less and the procedure time and bleeding are more, the incidence of sandwich vertebral fracture is not higher than that of ordinary adjacent vertebral body.
Collapse
Affiliation(s)
- Bo Yang
- Graduate School of Xi’an Medical University, Xi’an, China
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
| | - Yu Zhao
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
| | - Yangxue Zhao
- Department of Orthopaedics, The Ninth Hospital of Xi’an, Xi’an, China
- * Correspondence: Yangxue Zhao, Department of Orthopaedics, The Ninth Hospital of Xi’an, No. 151, East Section of South 2nd Ring Road, Beilin District, Xi'an City, 710054, Xi'an, Shaanxi Province, China. (e-mail: )
| |
Collapse
|
7
|
Chen Z, Song C, Lin H, Sun J, Liu W. Does prophylactic vertebral augmentation reduce the refracture rate in osteoporotic vertebral fracture patients: a meta-analysis. 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 2021; 30:2691-2697. [PMID: 34132903 DOI: 10.1007/s00586-021-06899-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE In order to prevent the recurrent fracture after vertebral augmentation, the concept of prophylactic vertebral augmentation has been proposed, but its efficacy is still controversial. This study aimed to determine the efficacy of prophylactic vertebral augmentation for prevention of refracture in osteoporotic vertebral fracture patients. METHODS Following PRISMA guidelines, a literature search was performed using PubMed, Embase and Web of Science databases for relevant studies published until February 2021. A meta-analysis of randomized controlled trials and retrospective controlled trials comparing prophylactic group versus nonprophylactic group was conducted. The primary outcome was the incidence of new vertebral compression fracture (VCF), and secondary outcomes were incidence of adjacent vertebral fracture (AVF) and remote vertebral fracture (RVF). RESULTS A total of 6 studies encompassing 618 patients were included in the meta-analysis. The incidence of new VCF was reported in all six studies, and the result showed no significant difference between the two groups (OR: 0.509; 95% CI: 0.184-1.409). Four studies provided data on the incidence of AVF, and it was revealed that there was no significant difference between the two groups (OR: 0.689; 95% CI: 0.109-4.371). In view of the incidence of RVF, prophylactic group also did not differ significantly compared with nonprophylactic group (OR: 0.535; 95% CI: 0.167-1.709). CONCLUSIONS The current evidence suggested that prophylactic vertebral augmentation might not be appropriate to diminish the risk of new VCF. Therefore, there is a need to investigate the mechanism of refracture and explore other preventive regimens to reduce the risk.
Collapse
Affiliation(s)
- Zhi Chen
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Chenyang Song
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Hailin Lin
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China
| | - Jun Sun
- Department of Emergency, Zhaotong Traditional Chinese Medicine Hospital, Zhaotong, 657000, Yunnan, China
| | - Wenge Liu
- Department of Orthopedics Surgery, Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, China.
| |
Collapse
|
8
|
Jang HD, Kim EH, Lee JC, Choi SW, Kim K, Shin BJ. Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review. Asian Spine J 2020; 14:898-909. [PMID: 33373513 PMCID: PMC7788360 DOI: 10.31616/asj.2020.0594] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%-35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.
Collapse
Affiliation(s)
- Hae-Dong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eung-Ha Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Chul Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Sung-Woo Choi
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Kyungbum Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Byung-Joon Shin
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Seoul, Korea
| |
Collapse
|
9
|
Chen XS, Jiang JM, Sun PD, Zhang ZF, Ren HL. How the clinical dosage of bone cement biomechanically affects adjacent vertebrae. J Orthop Surg Res 2020; 15:370. [PMID: 32867845 PMCID: PMC7457480 DOI: 10.1186/s13018-020-01906-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 08/20/2020] [Indexed: 01/29/2023] Open
Abstract
Objective This study evaluated the biomechanical changes in the adjacent vertebrae under a physiological load (500 N) when the clinically relevant amount of bone cement was injected into fractured cadaver vertebral bodies. Methods The embalmed cadaver thoracolumbar specimens in which each vertebral body (T12–L2) had a BMD of < 0.75 g/cm2 were used for the experiment. For establishing a fracture model, the upper one third of the L1 vertebra was performed wedge osteotomy and the superior endplate was kept complete. Stiffness of specimens was measured in different states. Strain of the adjacent vertebral body and intervertebral disc were measured in pre-fracture, post-fracture, and after augmentation by non-contact optical strain measurement system. Results The average amount of bone cement was 4.4 ml (3.8–5.0 ml). The stiffness of after augmentation was significantly higher than the stiffness of post-fracture (p < 0.05), but still lower than pre-fracture stiffness (p < 0.05). After augmentation, the adjacent upper vertebral strain showed no significant difference (p > 0.05) with pre-fracture, while the strain of adjacent lower vertebral body was significantly higher than that before fracture (p < 0.05). In flexion, T12/L1 intervertebral disc strain was significantly greater after augmentation than after the fracture (p < 0.05), but there was no significant difference from that before the fracture (p > 0.05); L1/2 vertebral strain after augmentation was significantly less than that after the fracture (p < 0.05), but there was no significant difference from that before the fracture (p > 0.05). Conclusions PVP may therefore have partially reversed the abnormal strain state of adjacent vertebral bodies which was caused by fracture.
Collapse
Affiliation(s)
- Xu-Shi Chen
- Department of Spinal Surgery, Huizhou Municipal Central Hospital, Huizhou, Guangdong, China
| | - Jian-Ming Jiang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Pei-Dong Sun
- Guangdong Provincial Key Laboratory of Medical Biomechanics, School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhao-Fei Zhang
- Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, Guangdong, China.
| | - Hai-Long Ren
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| |
Collapse
|
10
|
Xiu J, Bu T, Yan Y, Wu Z, Yin Z, Lei W. Biomechanical study of space frame structure based on bone cement screw. Exp Ther Med 2020; 19:3650-3656. [PMID: 32373193 PMCID: PMC7197252 DOI: 10.3892/etm.2020.8659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/03/2019] [Indexed: 11/23/2022] Open
Abstract
Stability of space frame structures with bone cement screw reinforcement by biomechanical testing was analyzed. Seven complete human spine specimens with osteoporosis were selected. Three specimens were separated into 18 vertebral bodies. Nine vertebral bodies were randomly selected and bone cement screws were implanted on both sides. Bone cement was used to form a bridge at the front end of the two screws (single vertebral group A). The other nine vertebral bodies were implanted with cement screws on both sides, but the front ends of the two screws were not bridged (single vertebral group B). The remaining spine specimens were used for biomechanical testing of the overall stability of the three-dimensional frame. The four specimens were osteotomized, and then two specimens were randomly selected. Bone cement screws were implanted on both sides of the vertebral body, and a bone cement bridge was formed at the front end of the two screws to establish a three-dimensional frame structure (multi-vertebral group A). The other two spine specimens were implanted with cement screws on both sides of the vertebral body, but the front ends of the two screws were not bridged (multi-vertebral group B). A statistical difference was found between the extractive force of bridged and non-bridged specimens. Group B showed some loosening of screws after the test. The stability of the triangle structure screw, which was formed after the bridge was established at the front end of the single-vertebral bone cement screw, was significantly enhanced. Moreover, the stability was significantly improved after the three-dimensional frame structure was established in the multi-vertebral body group, providing a new method for clinical improvement of the stability and reliability of internal fixation in patients with severe osteoporosis and spinal disease.
Collapse
Affiliation(s)
- Jintao Xiu
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, P.R. China.,Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Tao Bu
- Medical Department, Lintong Rehabilitation Center, Xi'an, Shaanxi 710600, P.R. China
| | - Yabo Yan
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zixiang Wu
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zhanhai Yin
- Department of Orthopaedics, The First Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Wei Lei
- Department of Orthopaedics, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi 710032, P.R. China
| |
Collapse
|
11
|
Prophylactic vertebroplasty versus kyphoplasty in osteoporosis: A comprehensive biomechanical matched-pair study by in vitro compressive testing. Med Eng Phys 2019; 65:46-56. [PMID: 30733174 DOI: 10.1016/j.medengphy.2019.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/15/2019] [Accepted: 01/24/2019] [Indexed: 12/19/2022]
Abstract
Vertebroplasty and kyphoplasty are alternative augmentation techniques of osteoporotic vertebral compression fractures. However, shortly after augmentation, new vertebral compression fractures may occur, mostly in the adjacent vertebrae. To prevent this, prophylactic cement injection can be applied to the neighboring vertebral bodies. Although there are many evidence-based clinical studies on the potential hazards of vertebroplasty and kyphoplasty, there are only few studies comparing the prophylactic potential of the two treatments. In this matched-pair experimental biomechanical study, the two treatments were compared via destructive compressive testing of 76 non-fractured osteoporotic human lumbar vertebral bodies from 24 cadavers, augmented pair-wise with vertebroplasty or kyphoplasty. Strength, stiffness and deformability were analyzed in terms of donor age, CT-based bone density, vertebral morphometry, and cement-endplate contacts. These were investigated in a paired analysis and also in terms of the number of cement-endplate contacts. Vertebroplasty resulted in significantly, but only 19% larger stiffness, approximately equal failure load and smaller failure displacement compared to kyphoplasty. Cement-endplate contacts affect augmentation differently for the two techniques, namely, strength significantly increased with increasing number of contacts in vertebroplasty, but decreased in kyphoplasty. The reasons for these contrasting behavior included the fundamentally different augmentation method, the resulting different construction and location of cement clouds and the different form and location of failure. These results indicate that both prophylactic vertebroplasty and kyphoplasty of non-fractured adjacent vertebrae may be advantageous to avoid subsequent fractures after post-fracture vertebroplasty and kyphoplasty, respectively. However, cement bridging in vertebroplasty and central cement placement in kyphoplasty are advantageous in prevention.
Collapse
|
12
|
DANESI VALENTINA, FALDINI CESARE, CRISTOFOLINI LUCA. METHODS FOR THE CHARACTERIZATION OF THE LONG-TERM MECHANICAL PERFORMANCE OF CEMENTS FOR VERTEBROPLASTY AND KYPHOPLASTY: CRITICAL REVIEW AND SUGGESTIONS FOR TEST METHODS. J MECH MED BIOL 2018. [DOI: 10.1142/s0219519417300022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is a growing interest towards bone cements for use in vertebroplasty and kyphoplasty, as such spine procedures are becoming more and more common. Such cements feature different compositions, including both traditional acrylic cements and resorbable and bioactive materials. Due to the different compositions and intended use, the mechanical requirements of cements for spinal applications differ from those of traditional cements used in joint replacement. Because of the great clinical implications, it is very important to assess their long-term mechanical competence in terms of fatigue strength and creep. This paper aims at offering a critical overview of the methods currently adopted for such mechanical tests. The existing international standards and guidelines and the literature were searched for publications relevant to fatigue and creep of cements for vertebroplasty and kyphoplasty. While standard methods are available for traditional bone cements in general, no standard indicates specific methods or acceptance criteria for fatigue and creep of cements for vertebroplasty and kyphoplasty. Similarly, a large number of papers were published on cements for joint replacements, but only few cover fatigue and creep of cements for vertebroplasty and kyphoplasty. Furthermore, the literature was analyzed to provide some indications of tests parameters and acceptance criteria (number of cycles, duration in time, stress levels, acceptable amount of creep) for possible tests specifically relevant to cements for spinal applications.
Collapse
Affiliation(s)
- VALENTINA DANESI
- Department of Industrial Engineering, Alma Mater Studiorum — Università di Bologna, Italy
| | - CESARE FALDINI
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum — Università di Bologna, Italy
- Department of Orthopaedics and Trauma Surgery, Università di Bologna — Istituto Ortopedico Rizzoli, Bologna, Italy
| | - LUCA CRISTOFOLINI
- Department of Industrial Engineering, Alma Mater Studiorum — Università di Bologna, Italy
| |
Collapse
|
13
|
Sabo A, Hatgis J, Granville M, Jacobson RE. Multilevel Contiguous Osteoporotic Lumbar Compression Fractures: The Relationship of Scoliosis to the Development of Cascading Fractures. Cureus 2017; 9:e1962. [PMID: 29492351 PMCID: PMC5820015 DOI: 10.7759/cureus.1962] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Osteoporotic patients can present with either single or multiple fractures secondary to repeated falls and progressive osteoporosis. Multiple fractures often lead to additional spinal deformity and are a sign of more severe osteoporosis. In the thoracic spine, multiple fractures are associated with the development of gradual thoracic kyphosis but neurologic deficits are uncommon. In the lumbar spine, patients with multiple lumbar fractures have more constant lumbar pain, may have symptoms related to concurrent lumbar stenosis or degenerative scoliosis, and may present with radiculopathy, especially with fractures at L4 and L5. In a review of a series of patients with recurrent multiple lumbar fractures or 'cascading' fractures, it was found that all the patients were female, had severe osteoporosis, often untreated, had a previous history of multiple previous thoracic and lumbar fractures, and all had associated scoliotic spinal deformities ranging from 6o to 50o. It was found that if the curve progressed and the greater the degree of curvature, the more frequently subsequent multiple fractures developed, leading to recurrent acute episodes of pain. Forty percent also had additional sacral insufficiency fractures, an unusually high percentage. Biomechanically, the lumbar spine is both more mobile and supports a larger portion of the spinal load compared to the thoracic spine. The existence or worsening of a lumbar spinal deformity from degenerative lumbar scoliosis shifts the mechanical forces more to one side on already weakened osteoporotic lumbar vertebrae and sacrum, leading to an increased incidence of these fractures. Because of the chronic and uneven lower lumbar spinal load with severe vertebral osteoporosis in certain patients with repeat lumbar fractures and worsening degenerative lumbar scoliosis, there may be a rationale to add preventive vertebroplasty at adjacent vertebral endplates when treating acute recurrent lumbar fractures to decrease the incidence of recurrence in other vertebrae.
Collapse
Affiliation(s)
- Alex Sabo
- Neurology, Pain Management, Nova Southeast/larkin Community Hospital
| | - Jesse Hatgis
- Pain Management, Phoenix Neurological and Pain Institute
| | | | | |
Collapse
|
14
|
Abstract
RATIONALE Balloon kyphoplasty is a widely accepted treatment of osteoporotic vertebral compression fractures (OVCFs) with good results and a low risk for complications. A refracture of previously treated vertebra is a relatively rare condition. PATIENT CONCERNS We reported our 3 cases and reviewed all relevant literatures of 11 cases with refracture of osteoporotic vertebral body after kyphoplasty. DIAGNOSES Follow-up radiographs or magnetic resonance imaging examination confirmed refractures of previously treated vertebrae after kyphoplasty. INTERVENTIONS One patient with 1 refracture of osteoporotic vertebral body after kyphoplasty was treated conservatively, but the other 2 patients were treated surgically because of multiple vertebral fractures or neurological deficits. OUTCOMES The average age of the patients was 76.8 years (range, 63-86 years). All the patients had severe osteoporosis with a mean T-score of -3.46 (range -5.0 to -3.0). The sites of refractures are in the lumbar and thoracolumbar regions. Severe osteoporosis, the presence of intravertebral cleft, and a solid lump injection pattern of polymethylmethacrylate would result in insufficient strengthening effects of cement augmentation and therefore increased the likelihood of refractures of the kyphoplasty vertibrae. LESSONS Patients with OVCFs and intravertebral cleft who did not obtain complete pain-relief at the treated vertebral level after kyphoplasty should be strictly followed up. Early finding of this condition and rapid intervention might contribute to avoiding the occurrence of the cemented vertebral refracture after kyphoplasty. Conservative treatments such as back brace and antiosteoporotic medications were strongly recommended.
Collapse
|
15
|
Gačanin J, Kovtun A, Fischer S, Schwager V, Quambusch J, Kuan SL, Liu W, Boldt F, Li C, Yang Z, Liu D, Wu Y, Weil T, Barth H, Ignatius A. Spatiotemporally Controlled Release of Rho-Inhibiting C3 Toxin from a Protein-DNA Hybrid Hydrogel for Targeted Inhibition of Osteoclast Formation and Activity. Adv Healthc Mater 2017; 6. [PMID: 28758712 DOI: 10.1002/adhm.201700392] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/10/2017] [Indexed: 12/17/2022]
Abstract
In osteoporosis, bone structure can be improved by the introduction of therapeutic molecules inhibiting bone resorption by osteoclasts. Here, biocompatible hydrogels represent an excellent option for the delivery of pharmacologically active molecules to the bone tissue because of their biodegradability, injectability, and manifold functionalization capacity. The present study reports the preparation of a multifunctional hybrid hydrogel from chemically modified human serum albumin and rationally designed DNA building blocks. The hybrid hydrogel combines advantageous characteristics, including rapid gelation through DNA hybridization under physiological conditions and a self-healing and injectable nature with the possibility of specific loading and spatiotemporally controlled release of active proteins, making it an advanced biomaterial for the local treatment of bone diseases, for example, osteoporosis. The hydrogels are loaded with a recombinant Rho-inhibiting C3 toxin, C2IN-C3lim-G205C. This toxin selectively targets osteoclasts and inhibits Rho-signaling and, thereby, actin-dependent processes in these cells. Application of C2IN-C3lim-G205C toxin-loaded hydrogels effectively reduces osteoclast formation and resorption activity in vitro, as demonstrated by tartrate-resistant acid phosphatase staining and the pit resorption assay. Simultaneously, osteoblast activity, viability, and proliferation are unaffected, thus making C2IN-C3lim-G205C toxin-loaded hybrid hydrogels an attractive pharmacological system for spatial and selective modulation of osteoclast functions to reduce bone resorption.
Collapse
Affiliation(s)
- Jasmina Gačanin
- Institute of Organic Chemistry III; University of Ulm; 89081 Ulm Germany
| | - Anna Kovtun
- Institute of Orthopedic Research and Biomechanics; Trauma Research Center; University of Ulm; 89081 Ulm Germany
| | - Stephan Fischer
- Institute of Pharmacology and Toxicology; University of Ulm; 89081 Ulm Germany
| | - Victoria Schwager
- Institute of Pharmacology and Toxicology; University of Ulm; 89081 Ulm Germany
| | - Johanna Quambusch
- Institute of Organic Chemistry III; University of Ulm; 89081 Ulm Germany
- Max Planck Institute for Polymer Research; 55128 Mainz Germany
| | - Seah Ling Kuan
- Max Planck Institute for Polymer Research; 55128 Mainz Germany
| | - Weina Liu
- Institute of Organic Chemistry III; University of Ulm; 89081 Ulm Germany
| | - Felix Boldt
- Institute of Organic Chemistry III; University of Ulm; 89081 Ulm Germany
| | - Chuang Li
- Key Laboratory of Organic Optoelectronics and Molecular Engineering of the Ministry of Education; Department of Chemistry; Tsinghua University; 100084 Beijing China
| | - Zhongqiang Yang
- Key Laboratory of Organic Optoelectronics and Molecular Engineering of the Ministry of Education; Department of Chemistry; Tsinghua University; 100084 Beijing China
| | - Dongsheng Liu
- Key Laboratory of Organic Optoelectronics and Molecular Engineering of the Ministry of Education; Department of Chemistry; Tsinghua University; 100084 Beijing China
| | - Yuzhou Wu
- Institute of Organic Chemistry III; University of Ulm; 89081 Ulm Germany
- Max Planck Institute for Polymer Research; 55128 Mainz Germany
- School of Chemistry and Chemical Engineering; Huazhong University of Science and Technology; 430074 Wuhan China
| | - Tanja Weil
- Institute of Organic Chemistry III; University of Ulm; 89081 Ulm Germany
- Max Planck Institute for Polymer Research; 55128 Mainz Germany
| | - Holger Barth
- Institute of Pharmacology and Toxicology; University of Ulm; 89081 Ulm Germany
| | - Anita Ignatius
- Institute of Orthopedic Research and Biomechanics; Trauma Research Center; University of Ulm; 89081 Ulm Germany
| |
Collapse
|
16
|
Kim HS, Ju CI. Spinal Instability Predictive Scoring System for Subsequent Fracture After Bone Cement Augmentation in Patients with Osteoporotic Vertebral Compression Fracture. World Neurosurg 2017; 106:736-745. [PMID: 28735136 DOI: 10.1016/j.wneu.2017.07.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 07/07/2017] [Accepted: 07/11/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Bone cement augmentation procedures (vertebroplasty and kyphoplasty) are the primary treatments for osteoporotic vertebral compression fracture (VCF). However, these procedures are associated with various problems resulting in subsequent fracture. The purpose of this study was to evaluate the spinal instability factors related to subsequent fracture after vertebral augmentation procedures. METHODS We retrospectively reviewed patients who underwent augmentation procedures for osteoporotic VCF. Between May 2011 and November 2014, 285 patients (vertebroplasty, n = 231; kyphoplasty, n = 54) were enrolled. Subsequent fractures were classified into 4 types based on the fracture patterns: 1) no subsequent fracture, 2) neofracture, 3) hammer fracture (new vertebral fractures involving another vertebra without a definitive history of trauma), and 4) kyphotic compression fracture. We analyzed subsequent fracture patterns and their occurrence rates according to factors that may induce subsequent fracture and developed a predictive scoring system with respect to the hammer fracture occurrence rate. We classified all cases into 4 groups (A,B,C,D) according to Spinal Instability Predictive Scoring System score. Groups A, B, C, and D were defined by total scores of 0∼5, 6∼10, 11∼15, and 16∼20, respectively. RESULTS The subsequent fracture types for vertebroplasty were as follows: no subsequent fracture (n = 112; 48.28%); hammer fracture (n = 65; 28.02%); neofracture (n = 35; 15.09%); and kyphotic compression fracture (n = 19; 8.19%). According to the total scores, the occurrence rate of subsequent hammer fracture (no subsequent fracture, hammer fracture, neofracture, and kyphotic compression fracture) were as follows: group A (84.21%, 0%, 10.52%, and 5.26%), group B (64.58%, 10.45%, 12.5%, and 12.5%), group C (39.39%, 33.3%, 15.15%, and 12.12%), and group D (11.67%, 63.3%, 21.67%, and 3.33%). CONCLUSIONS Predictive scores can be calculated and used to predict the possibility of subsequent fracture according to scores. Group D showed the highest predictive scores and will need more preventative treatment.
Collapse
Affiliation(s)
- Hyeun Sung Kim
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea
| | - Chang Il Ju
- Department of Neurosurgery, Chosun University Hospital, Seo-gu, Gwangju, Republic of Korea.
| |
Collapse
|
17
|
Gasbarrini A, Ghermandi R, Akman YE, Girolami M, Boriani S. Elastoplasty as a promising novel technique: Vertebral augmentation with an elastic silicone-based polymer. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:209-214. [PMID: 28202221 PMCID: PMC6197590 DOI: 10.1016/j.aott.2017.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/05/2017] [Accepted: 01/10/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) restores the stiffness and the strength of fractured vertebral bodies, but changes the pattern of the stress transfer. This effect may cause a secondary fracture of the adjacent vertebrae. Elastoplasty has emerged as a new technique to overcome this complication. The aim of this study is to retrospectively evaluate the clinical results of the elastoplasty procedure. MATERIALS AND METHODS Thirthy nine patients (9 males, 30 females, 87 spinal levels) were clinically evaluated pre and postoperatively in terms of pain relief, leakage and silicone embolism. The mean age was 67 (range 38-84) years. The mean follow up period was 12,5 months. The patients were evaluated radiologically for the presence of adjacent level fractures postoperatively. Complications were recorded. RESULTS The mean VAS score decreased from 7,5 to 3,5 during the last follow-up. Symptomatic silicone pulmonary embolism was not encountered in any patients. Leakage was observed in 5 (13%) cases. There was an adjacent level fracture in 1 case and another fracture which was not at the adjacent level in another one. A hematoma occurred in the needle entry site in a patient with trombocytopenia (<70,000). CONCLUSIONS Elastoplasty is a safe, promising technique in the treatment of vertebral compression fractures (VCFs). Symptomatic silicone pulmonary embolism is not observed. The material's stiffness is close to intact vertebrae. Therefore, elastoplasty may be a good viable option in the treatment of VCFs as it cause less complications and can prevent adjacent level fractures. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
Affiliation(s)
| | | | - Yunus Emre Akman
- Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey.
| | | | | |
Collapse
|
18
|
Answer to the Letter to the Editor of Ming Yang et al. concerning "Risk factors of new symptomatic vertebral compression fractures in osteoporotic patients undergone percutaneous vertebroplasty" by Ren HL et al. (2015) Eur Spine J;24(4):750-758. 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 2017; 26:1561-1563. [PMID: 28271276 DOI: 10.1007/s00586-017-5027-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/01/2017] [Indexed: 10/20/2022]
|
19
|
Behrbalk E, Uri O, Folman Y, Rickert M, Kaiser R, Boszczyk BM. Staged Correction of Severe Thoracic Kyphosis in Patients with Multilevel Osteoporotic Vertebral Compression Fractures. Global Spine J 2016; 6:710-720. [PMID: 27781192 PMCID: PMC5077718 DOI: 10.1055/s-0035-1569460] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/05/2015] [Indexed: 12/12/2022] Open
Abstract
Study Design Technical report. Objective Multilevel osteoporotic vertebral compression fractures may lead to considerable thoracic deformity and sagittal imbalance, which may necessitate surgical intervention. Correction of advanced thoracic kyphosis in patients with severe osteoporosis remains challenging, with a high rate of failure. This study describes a surgical technique of staged vertebral augmentation with osteotomies for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures. Methods Five patients (average age 62 ± 6 years) with multilevel osteoporotic vertebral compression fractures and severe symptomatic thoracic kyphosis underwent staged vertebral augmentation and surgical correction of their sagittal deformity. Clinical and radiographic outcomes were assessed retrospectively at a mean postoperative follow-up of 34 months. Results Patients' self-reported back pain decreased from 7.2 ± 0.8 to 3.0 ± 0.7 (0 to 10 numerical scale; p < 0.001). Patients' back-related disability decreased from 60 ± 10% to 29 ± 10% (0 to 100% Oswestry Disability Index; p < 0.001). Thoracic kyphosis was corrected from 89 ± 5 degrees to 40 ± 4 degrees (p < 0.001), and the sagittal vertical axis was corrected from 112 ± 83 mm to 38 ± 23 mm (p = 0.058). One patient had cement leakage without subsequent neurologic deficit. Decreased blood pressure was observed in another patient during the cement injection. No correction loss, hardware failure, or neurologic deficiency was seen in the other patients. Conclusion The surgical technique described here, despite its complexity, may offer a safe and effective method for the treatment of advanced thoracic kyphosis in patients with osteoporotic multilevel vertebral compression fractures.
Collapse
Affiliation(s)
- Eyal Behrbalk
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel,Address for correspondence Dr. Eyal Behrbalk The Spine Unit, Hillel-Yaffe Medical CenterHa-Shalom Street, Hadera, 38100Israel
| | - Ofir Uri
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Yoram Folman
- The Spine Unit, Hillel-Yaffe Medical Center, Hadera, Israel
| | - Marcus Rickert
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Radek Kaiser
- The Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham, United Kingdom
| | | |
Collapse
|
20
|
Danesi V, Tozzi G, Cristofolini L. Application of digital volume correlation to study the efficacy of prophylactic vertebral augmentation. Clin Biomech (Bristol, Avon) 2016; 39:14-24. [PMID: 27631716 DOI: 10.1016/j.clinbiomech.2016.07.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prophylactic augmentation is meant to reinforce the vertebral body, but in some cases it is suspected to actually weaken it. Past studies only investigated structural failure and the surface strain distribution. To elucidate the failure mechanism of the augmented vertebra, more information is needed about the internal strain distribution. This study aims to measure, for the first time, the full-field three-dimensional strain distribution inside augmented vertebrae in the elastic regime and to failure. METHODS Eight porcine vertebrae were prophylactically-augmented using two augmentation materials. They were scanned with a micro-computed tomography scanner (38.8μm voxel resolution) while undeformed, and loaded at 5%, 10%, and 15% compressions. Internal strains (axial, antero-posterior and lateral-lateral components) were computed using digital volume correlation. FINDINGS For both augmentation materials, the highest strains were measured in the regions adjacent to the injected cement mass, whereas the cement-interdigitated-bone was less strained. While this was already visible in the elastic regime (5%), it was a predictor of the localization of failure, which became visible at higher degrees of compression (10% and 15%), when failure propagated across the trabecular bone. Localization of high strains and failure was consistent between specimens, but different between the cement types. INTERPRETATION This study indicated the potential of digital volume correlation in measuring the internal strain (elastic regime) and failure in augmented vertebrae. While the cement-interdigitated region becomes stiffer (less strained), the adjacent non-augmented trabecular bone is affected by the stress concentration induced by the cement mass. This approach can help establish better criteria to improve vertebroplasty.
Collapse
Affiliation(s)
- Valentina Danesi
- Department of Industrial Engineering, Alma Mater Studiorum, Università di Bologna, Italy
| | - Gianluca Tozzi
- School of Engineering, University of Portsmouth, United Kingdom.
| | - Luca Cristofolini
- Department of Industrial Engineering, Alma Mater Studiorum, Università di Bologna, Italy
| |
Collapse
|
21
|
Eichler MC, Spross C, Ewers A, Mayer R, Külling FA. Prophylactic adjacent-segment vertebroplasty following kyphoplasty for a single osteoporotic vertebral fracture and the risk of adjacent fractures: a retrospective study and clinical experience. J Neurosurg Spine 2016; 25:528-534. [DOI: 10.3171/2016.2.spine15907] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
This study investigated the benefit of prophylactic vertebroplasty of the adjacent vertebrae in single-segment osteoporotic vertebral body fractures treated with kyphoplasty.
METHODS
All patients treated with kyphoplasty for osteoporotic single-segment fractures between January 2007 and August 2012 were included in this retrospective study. The patients received either kyphoplasty alone (kyphoplasty group) or kyphoplasty with additional vertebroplasty of the adjacent segment (vertebroplasty group). The segmental kyphosis with the rate of adjacent-segment fractures (ASFs) and remote fractures were studied on plain lateral radiographs preoperatively, postoperatively, at 3 months, and at final follow-up.
RESULTS
Thirty-seven (82%) of a possible 45 patients were included for the analysis, with a mean follow-up of 16 months (range 3–54 months). The study population included 31 women, and the mean age of the total patient population was 72 years old (range 53–86 years). In 21 patients (57%), the fracture was in the thoracolumbar junction. Eighteen patients were treated with additional vertebroplasty and 19 with kyphoplasty only. The segmental kyphosis increased in both groups at final follow-up. A fracture through the primary treated vertebra (kyphoplasty) was found in 4 (22%) of the vertebroplasty group and in 3 (16%) of the kyphoplasty group (p = 0.6). An ASF was found in 50% (n = 9) of the vertebroplasty group and in 16% (n = 3) of the kyphoplasty group (p = 0.03). Remote fractures occurred in 1 patient in each group (p = 1.0).
CONCLUSIONS
Prophylactic vertebroplasty of the adjacent vertebra in patients with single-segment osteoporotic fractures as performed in this study did not decrease the rate of adjacent fractures. Based on these retrospective data, the possible benefits of prophylactic vertebroplasty do not compensate for the possible risks of an additional cement augmentation.
Collapse
Affiliation(s)
- Martin C. Eichler
- 1Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Switzerland
| | - Christian Spross
- 1Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Switzerland
| | - Alexander Ewers
- 2Department of Orthopaedics and Traumatolgoy, Spital Herisau, Switzerland; and
| | - Ryan Mayer
- 3School of Medicine, University of California, Irvine, California
| | - Fabrice A. Külling
- 1Department of Orthopaedics and Traumatology, Kantonsspital St. Gallen, Switzerland
| |
Collapse
|
22
|
CRISTOFOLINI LUCA, BRANDOLINI NICOLA, DANESI VALENTINA, ERANI PAOLO, VICECONTI MARCO, FERGUSON STEPHENJ. A PRELIMINARY IN VITRO BIOMECHANICAL EVALUATION OF PROPHYLACTIC CEMENT AUGMENTATION OF THE THORACOLUMBAR VERTEBRAE. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In this paper, the biomechanical effectiveness of prophylactic augmentation in preventing fracture was investigated. In vitro biomechanical tests were performed to assess which factors make prophylactic augmentation effective/ineffective in reducing fracture risk. Nondestructive and destructive in vitro tests were performed on isolated osteoporotic vertebrae. Five sets of three-adjacent-vertebrae were tested. The central vertebra of each triplet was tested in the natural condition (control) non-destructively (axial-compression, torsion) and destructively (axial-compression). The two adjacent vertebrae were first tested nondestructively (axial-compression, torsion) pre-augmentation; prophylactic augmentation (uni- or bi-pedicular access) was then performed delivering 5.04[Formula: see text]mL to 8.44[Formula: see text]mL of acrylic cement by means of a customized device; quality of augmentation was CT-assessed; the augmented vertebrae were re-tested nondestructively (axial-compression, torsion), and eventually loaded to failure (axial-compression). Vertebral stiffness was correlated with the first-failure, but not with ultimate failure. The force and work to ultimate failure in prophylactic-augmented vertebrae was consistently larger than in the controls. However, in some cases the first-failure force and work in the augmented vertebrae were lower than for the controls. To investigate the reasons for such unpredictable results, the correlation with augmentation quality was analyzed. Some augmentation parameters seemed more correlated with mechanical outcome (statistically not-significant due to the limited sample size): uni-pedicular access resulted in a single cement mass, which tended to increase the force and work to first- and ultimate failure. The specimens with the highest strength and toughness also had: at least 25% cement filling, cement mass shifted anteriorly, and cement-endplate contact. These findings seem to confirm that prophylactic augmentation may aid reducing the risk of fracture. However, inadequate augmentation may have detrimental consequences. This study suggests that, to improve the strength of the augmented vertebrae, more attention should be dedicated to the quality of augmentation in terms of amount and position of the injected cement.
Collapse
Affiliation(s)
- LUCA CRISTOFOLINI
- Department of Industrial Engineering, School of Engineering and Architecture, Viale Risorgimento 2, University of Bologna, Italy
| | - NICOLA BRANDOLINI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, Italy
| | - VALENTINA DANESI
- Department of Industrial Engineering, School of Engineering and Architecture, Viale Risorgimento 2, University of Bologna, Italy
| | - PAOLO ERANI
- Laboratorio di Tecnologia Medica, Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, Bologna, Italy
| | - MARCO VICECONTI
- Department of Mechanical Engineering and Insigneo, Institute for in Silico Medicine, The University of Sheffield, Mappin St, Sheffield, S1 3JD, United Kingdom
| | | |
Collapse
|
23
|
Hoppe S, Budmiger M, Bissig P, Aghayev E, Benneker LM. Lordoplasty: midterm outcome of an alternative augmentation technique for vertebral fractures. J Neurosurg Spine 2016; 24:922-7. [PMID: 26895528 DOI: 10.3171/2015.10.spine151016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Vertebroplasty and balloon kyphoplasty are effective treatment options for osteoporotic vertebral compression fractures but are limited in correction of kyphotic deformity. Lordoplasty has been reported as an alternative, cost-effective, minimally invasive, percutaneous cement augmentation technique with good restoration of vertebral body height and alignment. The authors report on its clinical and radiological midterm results. METHODS A retrospective review was conducted of patients treated with lordoplasty from 2002 to 2014. Inclusion criteria were clinical and radiological follow-up evaluations longer than 24 months. Radiographs were accessed regarding initial correction and progressive loss of reduction. Complications and reoperations were recorded. Actual pain level, pain relief immediately after surgery, autonomy, and subjective impression of improvement of posture were assessed by questionnaire. RESULTS Sixty-five patients (46 women, 19 men, age range 38.9-86.2 years old) were treated with lordoplasty for 69 vertebral compression and insufficiency fractures. A significant correction of the vertebral kyphotic angle (mean 13°) and segmental kyphotic angle (mean 11°) over a mean follow-up of 33 months (range 24-108 months) was achieved (p < 0.001). On average, pain was relieved to 90% of the initial pain level. In 24% of the 65 patients a second spinal intervention was necessary: 16 distant (24.6%) and 7 adjacent (10.8%) new osteoporotic fractures, 4 instrumented stabilizations (6.2%), 1 new adjacent traumatic fracture (1.5%), and 1 distant microsurgical decompression (1.5%). Cement leakage occurred in 10.4% but was only symptomatic in 1 case. CONCLUSIONS Lordoplasty appeared safe and effective in midterm pain alleviation and restoration of kyphotic deformity in osteoporotic compression and insufficiency fractures. The outcomes of lordoplasty are consistent with other augmentation techniques.
Collapse
Affiliation(s)
- Sven Hoppe
- Department of Orthopedic Surgery, Inselspital, and
| | | | | | - Emin Aghayev
- Institute for Evaluative Research in Medicine, University of Bern, Switzerland
| | | |
Collapse
|
24
|
Abstract
Demographic trends make it incumbent on orthopaedic spine surgeons to recognize the special challenges involved in caring for older patients with spine pathology. Unique pathologies, such as osteoporosis and degenerative deformities, must be recognized and dealt with. Recent treatment options and recommendations for the medical optimization of bone health include vitamin D and calcium supplementation, diphosphonates, and teriparatide. Optimizing spinal fixation in elderly patients with osteoporosis is critical; cement augmentation of pedicle screws is promising. In the management of geriatric odontoid fractures, nonsurgical support with a collar may be considered for the low-demand patient, whereas surgical fixation is favored for high-demand patients. Management of degenerative deformity must address sagittal plane balance, including consideration of pelvic incidence. Various osteotomies may prove helpful in this setting.
Collapse
|
25
|
Elder BD, Lo SFL, Holmes C, Goodwin CR, Kosztowski TA, Lina IA, Locke JE, Witham TF. The biomechanics of pedicle screw augmentation with cement. Spine J 2015; 15:1432-45. [PMID: 25797809 DOI: 10.1016/j.spinee.2015.03.016] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/08/2015] [Accepted: 03/16/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A persistent challenge in spine surgery is improving screw fixation in patients with poor bone quality. Augmenting pedicle screw fixation with cement appears to be a promising approach. PURPOSE The purpose of this study was to survey the literature and assess the previous biomechanical studies on pedicle screw augmentation with cement to provide in-depth discussions of the biomechanical benefits of multiple parameters in screw augmentation. STUDY DESIGN/SETTING This is a systematic literature review. METHODS A search of Medline was performed, combining search terms of pedicle screw, augmentation, vertebroplasty, kyphoplasty, polymethylmethacrylate, calcium phosphate, or calcium sulfate. The retrieved articles and their references were reviewed, and articles dealing with biomechanical testing were included in this article. RESULTS Polymethylmethacrylate is an effective material for enhancing pedicle screw fixation in both osteoporosis and revision spine surgery models. Several other calcium ceramics also appear promising, although further work is needed in material development. Although fenestrated screw delivery appears to have some benefits, it results in similar screw fixation to prefilling the cement with a solid screw. Some differences in screw biomechanics were noted with varying cement volume and curing time, and some benefits from a kyphoplasty approach over a vertebroplasty approach have been noted. Additionally, in cadaveric models, cemented-augmented screws were able to be removed, albeit at higher extraction torques, without catastrophic damage to the vertebral body. However, there is a risk of cement extravasation leading to potentially neurological or cardiovascular complications with cement use. A major limitation of these reviewed studies is that biomechanical tests were generally performed at screw implantation or after a limited cyclic loading cycle; thus, the results may not be entirely clinically applicable. This is particularly true in the case of the bioactive calcium ceramics, as these biomechanical studies would not have measured the effects of osseointegration. CONCLUSIONS Polymethylmethacrylate and various calcium ceramics appear promising for the augmentation of pedicle screw fixation biomechanically in both osteoporosis and revision spine surgery models. Further translational studies should be performed, and the results summarized in this review will need to be correlated with the clinical outcomes.
Collapse
Affiliation(s)
- Benjamin D Elder
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA.
| | - Sheng-Fu L Lo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Christina Holmes
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Courtney R Goodwin
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Thomas A Kosztowski
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Ioan A Lina
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - John E Locke
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| | - Timothy F Witham
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287, USA
| |
Collapse
|
26
|
Liang D, Ye LQ, Jiang XB, Yang P, Zhou GQ, Yao ZS, Zhang SC, Yang ZD. Biomechanical effects of cement distribution in the fractured area on osteoporotic vertebral compression fractures: a three-dimensional finite element analysis. J Surg Res 2015; 195:246-56. [PMID: 25634828 DOI: 10.1016/j.jss.2014.12.053] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 12/07/2014] [Accepted: 12/31/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND According to some clinical studies, insufficient cement distribution (ID) in the fractured area and asymmetrical cement distribution around the fractured area were thought to be the reasons for unrelieved pain and recollapse after percutaneous vertebral augmentation (PVA) in the treatment of symptomatic osteoporotic vertebral compression fractures. METHODS Finite element methods were used to investigate the biomechanical variance among three patterns of cement distribution (ID and sufficient cement distribution in the fractured area and asymmetrical cement distribution around the fractured area including upward [BU] and downward [BD] cement distribution). RESULTS Compared with fractured vertebra before PVA, distribution of von Mises stress in the cancellous bone was transferred to be concentrated at the cancellous bone surrounding cement after PVA, whereas it was not changed in the cortical bone. Compared with sufficient cement distribution group, maximum von Mises stress in the cancellous bone and cortical bone and maximum displacement of augmented vertebra increased significantly in the ID group, whereas asymmetrical cement distribution around the fractured area in BU and BD groups mainly increased maximum von Mises stress in the cancellous bone significantly. Similar results could be seen in all loading conditions. CONCLUSIONS ID in the fractured area may lead to unrelieved pain after PVA in the treatment of symptomatic osteoporotic vertebral compression fractures as maximum displacement of augmented vertebral body increased significantly. Both ID in the fractured area and asymmetrical cement distribution around the fractured area are more likely to induce recollapse of augmented vertebra because they increased maximum von Mises stress in the cancellous bone and cortical bone of augmented vertebra significantly.
Collapse
Affiliation(s)
- De Liang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Lin-Qiang Ye
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Xiao-Bing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Department of Digital Orthopaedics and Biomechanics, Laboratory Affiliated to National Key Discipline of Orthopaedics and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China.
| | - Pan Yang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Orthopaedics Hospital, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou, Guangdong, People's Republic of China
| | - Guang-Quan Zhou
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China; Department of Digital Orthopaedics and Biomechanics, Laboratory Affiliated to National Key Discipline of Orthopaedics and Traumatology of Chinese Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Zhen-Song Yao
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Shun-Cong Zhang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| | - Zhi-Dong Yang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, People's Republic of China
| |
Collapse
|
27
|
Leasure JM, Buckley J. Biomechanical evaluation of an interfacet joint decompression and stabilization system. J Biomech Eng 2014; 136:1812592. [PMID: 24389961 DOI: 10.1115/1.4026363] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 12/30/2013] [Indexed: 11/08/2022]
Abstract
A majority of the middle-aged population exhibit cervical spondylosis that may require decompression and fusion of the affected level. Minimally invasive cervical fusion is an attractive option for decreasing operative time, morbidity, and mortality rates. A novel interfacet joint spacer (DTRAX facet screw system, Providence Medical) promises minimally invasive deployment resulting in decompression of the neuroforamen and interfacet fusion. The present study investigates the effectiveness of the device in minimizing intervertebral motion to promote fusion, decompression of the nerve root during bending activity, and performance of the implant to adhere to anatomy during repeated bending loads. We observed flexion, extension, lateral bending, and axial rotation resonant overshoot mode (ROM) in cadaver models of c-spine treated with the interfacet joint spacer (FJ spacer) as stand-alone and supplementing anterior plating. The FJ spacer was deployed bilaterally at single levels. Specimens were placed at the limit of ROM in flexion, extension, axial bending, and lateral bending. 3D images of the foramen were taken and postprocessed to quantify changes in foraminal area. Stand-alone spacer specimens were subjected to 30,000 cycles at 2 Hz of nonsimultaneous flexion-extension and lateral bending under compressive load and X-ray imaged at regular cycle intervals for quantitative measurements of device loosening. The stand-alone FJ spacer increased specimen stiffness in all directions except extension. 86% of all deployments resulted in some level of foraminal distraction. The rate of effective distraction was maintained in flexed, extended, and axially rotated postures. Two specimens demonstrated no detectable implant loosening (<0.25 mm). Three showed unilateral subclinical loosening (0.4 mm maximum), and one had subclinical loosening bilaterally (0.5 mm maximum). Results of our study are comparable to previous investigations into the stiffness of other stand-alone minimally invasive technologies. The FJ spacer system effectively increased stiffness of the affected level comparable to predicate systems. Results of this study indicate the FJ spacer increases foraminal area in the cervical spine, and decompression is maintained during bending activities. Clinical studies will be necessary to determine whether the magnitude of decompression observed in this cadaveric study will effectively treat cervical radiculopathy; however, results of this study, taken in context of successful decompression treatments in the lumbar spine, are promising for the continued development of this product. Results of this biomechanical study are encouraging for the continued investigation of this device in animal and clinical trials, as they suggest the device is well fixated and mechanically competent.
Collapse
|
28
|
Aquarius R, Homminga J, Hosman AJF, Verdonschot N, Tanck E. Prophylactic vertebroplasty can decrease the fracture risk of adjacent vertebrae: An in vitro cadaveric study. Med Eng Phys 2014; 36:944-8. [DOI: 10.1016/j.medengphy.2014.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 03/07/2014] [Accepted: 03/23/2014] [Indexed: 11/28/2022]
|
29
|
Li X, Lou X, Lin X, Du J. Refracture of osteoporotic vertebral body concurrent with cement fragmentation at the previously treated vertebral level after balloon kyphoplasty: a case report. Osteoporos Int 2014; 25:1647-50. [PMID: 24554341 DOI: 10.1007/s00198-014-2626-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
Kyphoplasty has been shown to provide symptomatic relief of vertebral compression fractures refractory to medical therapy. However, few reports have focused on refracture of cemented vertebrae after kyphoplasty. The presence of cemented vertebrae refracture concurrent with cement fragmentation is an extremely rare condition. We reported an 86-year-old man with a T12 osteoporotic compression fracture undergoing the kyphoplasty treatment. The patient postoperatively continued to have back pain at the same level. The solid lumped polymethylmethacrylate (PMMA) mass and inadequate use and insufficient filling of PMMA cement were observed in postoperative radiographs and magnetic resonance image (MRI) examination. He refused to receive the surgical intervention, but had not strict compliance with oral anti-osteoporotic medications. Ten months postoperatively, refracture of osteoporotic vertebral body concurrent with cement fragmentation occurred at the previously kyphoplasty-treated vertebral level. Bone mineral analysis showed severe osteoporosis with a T-score of -4.0. The patient finally obtained therapeutic benefit of pain relief and bony union of T12 vertebral body by consistently adhering to anti-osteoporotic medication treatment. This case illustrated that patients who underwent kyphoplasty to treat osteoporotic vertebral compression fractures with intravertebral fracture should be strictly followed up and supervised in their anti-osteoporotic medication treatment. The interdigitation injection pattern of PMMA and sufficient PMMA filling with trabeculae in the kyphoplasty procedure also might prevent refracture of the cemented vertebrae concurrent with PMMA fragmentation.
Collapse
Affiliation(s)
- Xigong Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhejiang University, Qingchun Road 79, Hangzhou, 310003, Zhejiang Province, China
| | | | | | | |
Collapse
|
30
|
Pneumaticos SG, Triantafyllopoulos GK, Evangelopoulos DS, Hipp JA, Heggeness MH. Effect of vertebroplasty on the compressive strength of vertebral bodies. Spine J 2013; 13:1921-7. [PMID: 23981817 DOI: 10.1016/j.spinee.2013.06.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 03/17/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Percutaneous vertebroplasty has been used successfully for many years in the treatment of painful compressive vertebral fractures due to osteoporosis. PURPOSE To compare the effect of vertebroplasty on the compressive strength of unfractured vertebral bodies. STUDY DESIGN Biomechanical study on cadaveric thoracic vertebrae. METHODS Forty vertebral bodies from four cadaveric thoracic spines were used for this experiment. Before testing, each thoracic spine was submitted to bone density testing and radiographic evaluation to rule out any obvious fractures. Under image intensification, 6 mL of a mixture of polymethylmethacrylate (PMMA) with barium (8 g of barium/40 g of PMMA) was injected into every other vertebral body of each spine specimen. After vertebroplasty, all soft tissues were dissected from the spine, and the vertebral bodies were separated and potted for mechanical testing. Testing to failure was performed using a combination of axial compression and anterior flexion moments. Two pneumatic cylinders applied anterior and posterior loads at a distance ratio of 4:3 relative to the anterior vertebral body wall, whereas two additional cylinders applied lateral loads, each at a constant rate of 200 N/s. RESULTS The average failure loads for nonvertebroplasty specimens was 6724.02 ± 3291.70 N, whereas the specimens injected with PMMA failed at an average compressive force of 5770.50 ± 2133.72 N. No statistically significant difference in failure loads could be detected between intact specimens and those that had undergone vertebroplasty. CONCLUSIONS Under these specific loading conditions, no significant increase in compressive strength of the vertebral bodies could be documented. This suggests that some caution should be applied to the concept of "prophylactic" vertebroplasty in patients at risk for fracture.
Collapse
Affiliation(s)
- Spiros G Pneumaticos
- 3rd Department of Orthopaedic Surgery, University of Athens, Medical School, Nikis 2, 14562 Kifissia, Athens, Greece; Baylor College of Medicine, Baylor Clinic, 6620 Main St, 13th floor, Suite 1325, Houston, TX 77030, USA.
| | | | | | | | | |
Collapse
|
31
|
Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades. 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; 22:2695-701. [PMID: 23880868 DOI: 10.1007/s00586-013-2908-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/07/2013] [Accepted: 07/08/2013] [Indexed: 12/13/2022]
Abstract
PURPOSE Vertebral augmentation with PMMA is a widely applied treatment of vertebral osteoporotic compression fractures. Subsequent fractures are a common complication, possibly due to the relatively high stiffness of PMMA in comparison with bone. Silicone as an augmentation material has biomechanical properties closer to those of bone and might, therefore, be an alternative. The study aimed to investigate the biomechanical differences, especially stiffness, of vertebral bodies with two augmentation materials and two filling grades. METHODS Forty intact human osteoporotic vertebrae (T10-L5) were studied. Wedge fractures were produced in a standardized manner. For treatment, PMMA and silicone at two filling grades (16 and 35 % vertebral body fill) were assigned to four groups. Each specimen received 5,000 load cycles with a high load range of 20-65 % of fracture force, and stiffness was measured. Additional low-load stiffness measurements (100-500 N) were performed for intact and augmented vertebrae and after cyclic loading. RESULTS Low-load stiffness testing after cyclic loading normalized to intact vertebrae showed increased stiffness with 35 and 16 % PMMA (115 and 110 %) and reduced stiffness with 35 and 16 % silicone (87 and 82 %). After cyclic loading (high load range), the stiffness normalized to the untreated vertebrae was 361 and 304 % with 35 and 16 % PMMA, and 243 and 222 % with 35 and 16 % silicone augmentation. For both high and low load ranges, the augmentation material had a significant effect on the stiffness of the augmented vertebra, while the filling grade did not significantly affect stiffness. CONCLUSIONS This study for the first time directly compared the stiffness of silicone-augmented and PMMA-augmented vertebral bodies. Silicone may be a viable option in the treatment of osteoporotic fractures and it has the biomechanical potential to reduce the risk of secondary fractures.
Collapse
|
32
|
Anselmetti GC, Marcia S, Saba L, Muto M, Bonaldi G, Carpeggiani P, Marini S, Manca A, Masala S. Percutaneous vertebroplasty: Multi-centric results from EVEREST experience in large cohort of patients. Eur J Radiol 2012; 81:4083-6. [DOI: 10.1016/j.ejrad.2012.07.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 05/25/2012] [Accepted: 07/09/2012] [Indexed: 11/26/2022]
|
33
|
Wang JL, Chiang CK, Kuo YW, Chou WK, Yang BD. Mechanism of fractures of adjacent and augmented vertebrae following simulated vertebroplasty. J Biomech 2012; 45:1372-8. [DOI: 10.1016/j.jbiomech.2012.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/25/2012] [Accepted: 03/02/2012] [Indexed: 01/08/2023]
|
34
|
Yen CH, Teng MMH, Yuan WH, Sun YC, Chang CY. Preventive vertebroplasty for adjacent vertebral bodies: a good solution to reduce adjacent vertebral fracture after percutaneous vertebroplasty. AJNR Am J Neuroradiol 2012; 33:826-32. [PMID: 22282447 DOI: 10.3174/ajnr.a2898] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Adjacent VCF frequently occurs after percutaneous vertebroplasty. Our aim was to evaluate PrVP in the prevention of PVNO-adjacent VCF. MATERIALS AND METHODS Radiographs of 68 patients who initially presented with a single-level unhealed fracture and underwent vertebroplasty were retrospectively reviewed for the occurrence of PVNO fracture. Patients in the nonpreventive group (n = 33) underwent TVP only for a vertebra with an unhealed fracture. The preventive group (n = 35) underwent PrVP combined with TVP. We injected bone cement into the caudal part of the superior adjacent vertebra and the cephalic part of the inferior adjacent vertebra to perform PrVP. RESULTS The incidences of PVNO fracture in adjacent vertebra next to a vertebra cemented at the patient's first vertebroplasty (within 6 months: 24% versus 3%, P = .012; within 1 year: 30% versus 3%, P = .006; >4 years: 39% versus 3%, P = .006) markedly decreased in the preventive group compared with the nonpreventive group. PVNO fracture was found in 26% of vertebrae adjacent to the first TVP level in the nonpreventive group and in 2% of vertebrae adjacent to a PrVP level in the preventive group after inclusion of all PrVP procedures. Approximately 33% of patients in the nonpreventive group underwent repeat vertebroplasty, mainly due to adjacent fractures. Only 3% of patients in the preventive group underwent repeated procedures. None of the vertebrae cemented for PrVP or TVP developed PVNO refracture. CONCLUSIONS Preventive vertebroplasty for the adjacent vertebra combined with TVP for the fractured vertebra is effective in the prevention of propagation of PVNO adjacent fractures, thus reducing the necessity of multiple repeat vertebroplasty procedures.
Collapse
Affiliation(s)
- C H Yen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
| | | | | | | | | |
Collapse
|
35
|
Anselmetti GC, Manca A, Hirsch J, Montemurro F, Isaia G, Osella G, Chiara G, Iussich G, Debernardi F, Regge D. Percutaneous Vertebroplasty in Osteoporotic Patients: An Institutional Experience of 1,634 Patients with Long-Term Follow-Up. J Vasc Interv Radiol 2011; 22:1714-20. [DOI: 10.1016/j.jvir.2011.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 08/18/2011] [Accepted: 09/03/2011] [Indexed: 11/15/2022] Open
|
36
|
New vertebral compression fractures after prophylactic vertebroplasty in osteoporotic patients. AJR Am J Roentgenol 2011; 197:451-6. [PMID: 21785093 DOI: 10.2214/ajr.10.5937] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Previous studies have shown the possible efficacy of prophylactic cement injection for nonfractured vertebrae during percutaneous vertebroplasty for compression fractures. The purpose of this study was to investigate risk factors for subsequent fractures after prophylactic percutaneous vertebroplasty. MATERIALS AND METHODS This retrospective study included 116 patients with osteoporotic compression fractures who underwent prophylactic percutaneous vertebroplasty. The patients were monitored with physical examinations and radiographs at 1 day and at 3 and 12 months after percutaneous vertebroplasty, and if back pain recurred. We analyzed the following multiple covariates to determine whether they were associated with recurrence: age, sex, steroid use, and the preoperative number of unhealed or chronic compression fractures. RESULTS Subsequent fractures in any vertebra occurred within 3 months after the procedure at 26 vertebrae in 21 patients (18.1%), and 36 occurred in 28 patients (24.1%) within 12 months. The occurrence of subsequent fractures within 12 months depended on the preoperative number of unhealed vertebrae: the occurrence rate was 16.9% (11/65) for one vertebra, 27.0% (10/37) for two vertebrae, and 50.0% (7/14) for three or more vertebrae. The incidence of subsequent fractures was significantly higher in patients with three or more fractures than in those with one fracture (p < 0.05). There were no statistically significant differences for the other factors. CONCLUSION Patients with three or more fractures tended to have subsequent fractures, despite undergoing prophylactic percutaneous vertebroplasty. However, there was no increased risk of subsequent fractures related to prophylactic percutaneous vertebroplasty.
Collapse
|
37
|
Farrokhi MR, Alibai E, Maghami Z. Randomized controlled trial of percutaneous vertebroplasty versus optimal medical management for the relief of pain and disability in acute osteoporotic vertebral compression fractures. J Neurosurg Spine 2011; 14:561-9. [PMID: 21375382 DOI: 10.3171/2010.12.spine10286] [Citation(s) in RCA: 173] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Osteoporotic vertebral compression fractures (VCFs) are a major cause of increased morbidity in older patients. This randomized controlled trial compared the efficacy of percutaneous vertebroplasty (PV) versus optimal medical therapy (OMT) in controlling pain and improving the quality of life (QOL) in patients with VCFs. Efficacy was measured as the incidence of new vertebral fractures after PV, restoration of vertebral body height (VBH), and correction of deformity. METHODS Of 105 patients with acute osteoporotic VCFs, 82 were eligible for participation: 40 patients underwent PV and 42 received OMT. Primary outcomes were control of pain and improvement in QOL before treatment, and these were measured at 1 week and at 2, 6, 12, 24, and 36 months after the beginning of the treatment. Radiological evaluation to measure VBH and sagittal index was performed before and after treatment in both groups and after 36 months of follow-up. RESULTS The authors found a statistically significant improvement in pain in the PV group compared with the OMT group at 1 week (difference -3.1, 95% CI -3.72 to -2.28; p < 0.001). The QOL improved significantly in the PV group (difference -14, 95% CI -15 to -12.82; p < 0.028). One week after PV, the average VBH restoration was 8 mm and the correction of deformity was 8°. The incidence of new fractures in the OMT group (13.3%) was higher than in the PV group (2.2%; p < 0.01). CONCLUSIONS The PV group had statistically significant improvements in visual analog scale and QOL scores maintained over 24 months, improved VBH maintained over 36 months, and fewer adjacent-level fractures compared with the OMT group.
Collapse
Affiliation(s)
- Majid Reza Farrokhi
- Neurosurgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
| | | | | |
Collapse
|
38
|
Comparison of kyphoplasty and lordoplasty in the treatment of osteoporotic vertebral compression fracture. Asian Spine J 2010; 4:102-8. [PMID: 21165313 PMCID: PMC2996621 DOI: 10.4184/asj.2010.4.2.102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Revised: 02/02/2010] [Accepted: 02/03/2010] [Indexed: 02/05/2023] Open
Abstract
STUDY DESIGN A retrospective study. PURPOSE To compare the level of restoration of the vertebral height, improvement in the wedge and kyphotic angles, and the incidence of complications in osteoporotic compression fracture in patients treated with either kyphoplasty or lordoplasty. OVERVIEW OF LITERATURE Kyphoplasty involves recompression of the vertebral bodies. Recently, a more effective method known as lordoplasty was introduced. METHODS Between 2004 and 2009, patients with osteoporotic thoracolumbar vertebral compression fractures were treated by either kyphoplasty (n = 24) or lordoplasty (n = 12) using polymethylmethacrylate (PMMA) cement, and the results of the two interventions were compared. A visual analogue scale was used to measure the pain status. Preoperative and postoperative radiographs were analyzed to quantify the anterior vertebral height restoration and the wedge and kyphotic alignment correction. RESULTS All patients in both groups reported a significant decrease in pain. The anterior heights increased 24.2% and 17.5% after the lordoplasty and kyphoplasty procedures, respectively (p < 0.05). Three months after the procedures, there was a larger decrease in the loss of anterior vertebral height in the kyphoplasty group (12.8%) than in the lordoplasty group (6.3%, p < 0.05). The wedge angles decreased after both procedures. The wedge angle in the lordoplasty group maintained its value after 3 months (p < 0.05). The kyphotic angular correction was 11.4 and 7.0° in the lordoplasty and kyphoplasty groups, respectively (p < 0.05). Both kyphotic deformities worsened to a similar degree of 5° after 3 months. CONCLUSIONS Lordoplasty is more useful than kyphoplasty in terms of the improved anatomic restoration and postoperative maintenance.
Collapse
|
39
|
|
40
|
Feasibility study of using viscoplastic bone cement for vertebroplasty: an in vivo clinical trial and in vitro cadaveric biomechanical examination. Spine (Phila Pa 1976) 2010; 35:E385-91. [PMID: 20393389 DOI: 10.1097/brs.0b013e3181c9f7fc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An in vivo clinical trial, and an in vitro cadaveric biomechanical and micromorphologic analysis. OBJECTIVE To find the feasibility of using viscoplastic bone cement for vertebroplasty. SUMMARY OF BACKGROUND DATA Vertebroplasty involved in bone cement reinforcement of fractured vertebra has shown promising clinical results. The most frequently observed complication of vertebroplasty is the cement leakage during surgery. Many methods were proposed and were successful at reducing the risk of leakage, such as creating a void within vertebra to reduce the injection pressure, increasing the cement viscosity to reduce the cement infiltration, etc. Nevertheless, a more cost-effective and safer surgery method is still the goal for many spine surgeons and researchers. METHODS To deliver the viscoplastic bone cement into the vertebra, a unipedicular tract and a void in the vertebra was created using a curette. The viscoplastic bone cement was then delivered into the void piece by piece and tamped for compactness with a blunt end tool. For the in vitro biomechanical test, 7 thoracic vertebrae were used. The intact specimens were compressed to lose 25% of its intact height, and then augmented with viscoplastic bone cement. Postaugmentation CT scanning was taken to examine the cement distribution, leakage path, and cement filling ratio within the vertebra. Postaugmentation compression test was conducted to examine the vertebral strength and stiffness, and then compared with the intact ones. Finally, the vertebrae were cut into slices for micromorphologic analysis. RESULTS The 6 in vivo clinical trials were all successfully operated with significant pain relief and showed no leakage during and after the surgery. The in vitro biomechanical test showed the cement augmentation significantly increased the vertebral strength (pre 3164 (229) N vs. post 3905 (484) N, P < 0.003), but tentatively decreased the vertebral stiffness (pre 1074 (74) N/mm vs. post 801 (370) N/mm, P = 0.081). The postaugmentation CT scanning showed the cement was well confined within the vertebra and the cement filling ratio was 21% (ranged from 15% to 29%). The depth that the viscoplastic bone cement infiltrated into the cancellous bone was 3.5 (0.6) mm, which is less than the depth [8.3 (2.2) mm, P < 0.001] of standard viscous bone cement vertebroplasty. CONCLUSION Vertebroplasty using viscoplastic bone cement is clinically feasible and can effectively improve the vertebral strength and reduce the cement infiltration depth. The risk of cement leakage can also be decreased by using viscoplastic bone cement.
Collapse
|
41
|
Tancioni F, Lorenzetti M, Navarria P, Nozza A, Castagna L, Gaetani P, Aimar E, Levi D, Di Ieva A, Pisano P, Santoro A, Scorsetti M, Rodriguez y Baena R. Vertebroplasty for pain relief and spinal stabilization in multiple myeloma. Neurol Sci 2010; 31:151-7. [DOI: 10.1007/s10072-009-0197-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2008] [Accepted: 11/10/2009] [Indexed: 12/16/2022]
|