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Mondal S, MacManus DB, Banche-Niclot F, Vitale-Brovarone C, Fiorilli S, McCarthy HO, Dunne N. Finite element analysis of vertebroplasty in the osteoporotic T11-L1 vertebral body: Effects of bone cement formulation. J Biomed Mater Res B Appl Biomater 2024; 112:e35359. [PMID: 38247244 DOI: 10.1002/jbm.b.35359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/24/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
Vertebral compression fractures are one of the most severe clinical consequences of osteoporosis and the most common fragility fracture afflicting 570 and 1070 out of 100,000 men and women worldwide, respectively. Vertebroplasty (VP), a minimally invasive surgical procedure that involves the percutaneous injection of bone cement, is one of the most efficacious methods to stabilise osteoporotic vertebral compression fractures. However, postoperative fracture has been observed in up to 30% of patients following VP. Therefore, this study aims to investigate the effect of different injectable bone cement formulations on the stress distribution within the vertebrae and intervertebral discs due to VP and consequently recommend the optimal cement formulation. To achieve this, a 3D finite element (FE) model of the T11-L1 vertebral body was developed from computed tomography scan data of the spine. Osteoporotic bone was modeled by reducing the Young's modulus by 20% in the cortical bone and 74% in cancellous bone. The FE model was subjected to different physiological movements, such as extension, flexion, bending, and compression. The osteoporotic model caused a reduction in the average von Mises stress compared with the normal model in the T12 cancellous bone and an increment in the average von Mises stress value at the T12 cortical bone. The effects of VP using different formulations of a novel injectable bone cement were modeled by replacing a region of T12 cancellous bone with the materials. Due to the injection of the bone cement at the T12 vertebra, the average von Mises stresses on cancellous bone increased and slightly decreased on the cortical bone under all loading conditions. The novel class of bone cements investigated herein demonstrated an effective restoration of stress distribution to physiological levels within treated vertebrae, which could offer a potential superior alternative for VP surgery as their anti-osteoclastogenic properties could further enhance the appeal of their fracture treatment and may contribute to improved patient recovery and long-term well-being.
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Affiliation(s)
- Subrata Mondal
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
| | - David B MacManus
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- BRAIN Lab, School of Mechanical & Materials Engineering, University College Dublin, Dublin 4, Ireland
| | | | | | - Sonia Fiorilli
- Department of Applied Science and Technology, Politecnico di Torino, Turin, Italy
| | - Helen O McCarthy
- School of Pharmacy, Queen's University Belfast, Belfast, BT9 7 BL, UK
| | - Nicholas Dunne
- School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Centre for Medical Engineering Research, Dublin City University, Dublin 9, Ireland
- Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Dublin 2, Ireland
- Advanced Manufacturing Research Centre (I-Form), School of Mechanical and Manufacturing Engineering, Dublin City University, Dublin 9, Ireland
- Advanced Materials and Bioengineering Research Centre (AMBER), Trinity College Dublin, Dublin 2, Ireland
- Trinity Centre for Biomedical Engineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin 2, Ireland
- Advanced Processing Technology Research Centre, Dublin City University, Dublin 9, Ireland
- Biodesign Europe, Dublin City University, Dublin 9, Ireland
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Wang W, Liu H, Wu Z, Teng Y, Huang Y, Liu T, Yang H. A Comparison of Percutaneous Kyphoplasty with High-Viscosity and Low-Viscosity Bone Cement for Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Study. Geriatr Orthop Surg Rehabil 2022; 13:21514593221119625. [PMID: 36090795 PMCID: PMC9459459 DOI: 10.1177/21514593221119625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/13/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
Background Osteoporotic vertebral compression fracture (OVCF) has become a health issue
of worldwide concern. Percutaneous kyphoplasty (PKP) is one of the main
surgical methods for OVCFs. This study aimed to evaluate and compare the
clinical efficacy and safety of PKP with high- and low-viscosity bone cement
for OVCFs. Methods Totally 62 patients with single-level OVCF were enrolled in this study from
December 2018 to April 2021. Among them, 32 cases underwent PKP with
high-viscosity bone cement, while 30 cases underwent PKP with low-viscosity
bone cement. Visual analog scale (VAS) scores and Oswestry disability index
(ODI) scores were used in the pre- and post-operative period to assess
patients’ rehabilitation. Compression rates of anterior vertebra height
(AVH) and posterior vertebra height (PVH) were analyzed to evaluate the
restoration of vertebra height. Leakage rates and locations were recorded to
show clinical safety. Results VAS and ODI scores both significantly improved in 2 groups at 1 day, 1 month,
and 3 months after surgery. Compression rates of AVH and PVH at 1 day and
3 months after PKP were lower than those before surgery. However, there was
no significant difference in VAS scores, ODI scores, and compression rates
between both groups. However, PKP with high-viscosity bone cement achieved a
lower bone cement leakage rate significantly, which showed the safety of
high-viscosity bone cement in PKP. Conclusions PKP with high- and low-viscosity bone cement both improved the recovery of
patients and restored vertebra heights. Notably, PKP with high-viscosity
bone cement can achieve favorable clinical outcomes as well as lower bone
cement leakage rate.
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Affiliation(s)
- Wenhao Wang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhikai Wu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yun Teng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yixue Huang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Suzhou, China
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Miao F, Zeng X, Wang W, Zhao Z. Percutaneous vertebroplasty with high- versus low-viscosity bone cement for osteoporotic vertebral compression fractures. J Orthop Surg Res 2020; 15:302. [PMID: 32762763 PMCID: PMC7412846 DOI: 10.1186/s13018-020-01835-y] [Citation(s) in RCA: 4] [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: 03/11/2020] [Accepted: 07/29/2020] [Indexed: 12/17/2022] Open
Abstract
Objective There is no consensus on the best choice between high- and low-viscosity bone cement for percutaneous vertebroplasty (PVP). This study aimed to compare the clinical and radiological outcomes and leakage between three cements with different viscosities in treating osteoporotic vertebral compression fractures. Methods This is a prospective study comparing patients who were treated with PVP under local anesthesia: group A (n = 99, 107 vertebrae) with high-viscosity OSTEOPAL V cement, group B (n = 79, 100 vertebrae) with low-viscosity OSTEOPAL V cement, and group C (n = 88, 102 vertebrae) with low-viscosity Eurofix VTP cement. Postoperative pain severity was evaluated using the visual analog scale. Cement leakage was evaluated using radiography and computed tomography. Results There was no significant difference in the incidence of cement leakage between the three groups (group A 20.6%, group B 24.2%, group C 20.6%, P = 0.767). All three groups showed significant reduction in postoperative pain scores but did not differ significantly in pain scores at postoperative 2 days (group A 2.01 ± 0.62, group B 2.15 ± 0.33, group C 1.92 ± 0.71, P = 0.646). During the 6 months after cement implantation, significantly less reduction in the fractured vertebral body height was noticed in group B and group C than in group A (group A 19.0%, group B 8.1%, group C 7.3%, P = 0.009). Conclusions Low-viscosity cement has comparable incidence of leakage compared to high-viscosity cement in PVP for osteoporotic vertebral compression fractures. It also can better prevent postoperative loss of fractured vertebral body’s height.
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Affiliation(s)
- Feng Miao
- Department of Spine Surgery, Renmin Hospital, Hubei University of Medicine, No.39 Middle Chaoyang Road, Shiyan, 442000, Hubei, China
| | - Xiaojun Zeng
- Department of Spine Surgery, Renmin Hospital, Hubei University of Medicine, No.39 Middle Chaoyang Road, Shiyan, 442000, Hubei, China.
| | - Wei Wang
- Department of Spine Surgery, Renmin Hospital, Hubei University of Medicine, No.39 Middle Chaoyang Road, Shiyan, 442000, Hubei, China
| | - Zhou Zhao
- Department of Spine Surgery, Renmin Hospital, Hubei University of Medicine, No.39 Middle Chaoyang Road, Shiyan, 442000, Hubei, China
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Li H, Wang Y, Wang R, Yue L, Chen S, Li C. Effects of rosuvastatin and zoledronic acid in combination on the recovery of senile osteoporotic vertebral compression fracture following percutaneous vertebroplasty. J Int Med Res 2020; 48:300060520925390. [PMID: 32459117 PMCID: PMC7278104 DOI: 10.1177/0300060520925390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objectives This study analyzed the effects of rosuvastatin and zoledronic acid in
combination on patient recovery following percutaneous vertebroplasty (PVP)
that was performed to treat senile osteoporotic vertebral compression. Methods Senile patients with osteoporotic vertebral compression fracture (n = 120)
were included in this retrospective study, and they were classified into two
groups. Those in the control group (n = 60) were treated with PVP + caltrate
and those in the observation group (n = 60) received this treatment with
combined zoledronic acid and rosuvastatin. Between-group comparisons were
made at both pre- and post-treatment regarding bone density, type I
procollagen peptide (CTX) and bone-specific alkaline phosphatase (BAP)
levels, visual analog scale (VAS) score, Oswestry Disability Index (ODI)
score, and adjacent centrum refracture. Results Bone density was higher and BAP and CTX levels as well as ODI and VAS scores
were lower at post-treatment in the observation group compared with the
control group. The refracture rate in the observation group was lower
compared with the control group. Conclusion Treatment with a combination of rosuvastatin and zoledronic acid following
PVP can improve the condition of senile osteoporotic vertebral compression
fracture and patient’s functional status, and it can also alleviate
pain.
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Affiliation(s)
- Hong Li
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Yu Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Rui Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Lei Yue
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Shunlun Chen
- Department of Orthopedics, Peking University First Hospital, Beijing, China
| | - Chunde Li
- Department of Orthopedics, Peking University First Hospital, Beijing, China
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Efficacy and Safety of High-Viscosity Bone Cement Vertebroplasty in Treatment of Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft. World Neurosurg 2019; 132:e739-e745. [PMID: 31415893 DOI: 10.1016/j.wneu.2019.08.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate and compare clinical outcomes and cement leakage of high-viscosity bone cement versus low-viscosity bone cement vertebroplasty in treating osteoporotic vertebral compression fractures with intravertebral cleft. METHODS The study included 72 patients with osteoporotic vertebral compression fractures with intravertebral cleft, who were divided into high-viscosity cement (HVC) (38 cases) and low-viscosity cement (LVC) (34 cases) groups according to the viscosity of bone cement used. Cement leakage, visual analog scale score, Oswestry Disability Index, and kyphotic angle (KA) were evaluated. RESULTS All patients were followed for at least 12 months. Overall cement leakage rate was 18.4% in the HVC group, lower than the rate of 61.8% obtained in the LVC group. A statistically significant difference was found in the overall cement leakage rate between the groups (P < 0.05). Visual analog scale and Oswestry Disability Index scores were significantly improved after percutaneous vertebroplasty without significant differences between the HVC and LVC groups (P > 0.05). The KA of patients from both groups was also significantly corrected immediately after surgery. Although the KA gradually increased in both groups during the follow-up period, there was no statistically significant difference between the HVC and LVC groups in KA during follow-up (P > 0.05). CONCLUSIONS Percutaneous vertebroplasty using HVC to treat osteoporotic vertebral compression fractures with intravertebral cleft significantly reduces cement leakage and improves the safety of the operation. In terms of clinical efficacy and prevention of augmented vertebral recollapse, HVC may not have obvious advantages.
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