A Biomechanical Analysis of Intravertebral Pressures During Vertebroplasty of Cadaveric Spines With and Without Simulated Metastases

Novel methodology for assessing biomaterial–biofluid interaction in cancellous bone

“…This is mainly because leakage into the surrounding vasculature can reach remote areas of the body, such as the lungs, and cause pulmonary embolisms [39][40][41]. The posterior leakage typically observed in the Lesion surrogate was similar to that reported by Reidy et al [31] who studied the cement filling pattern in seven osteoporotic human vertebrae with simulated lytic lesion. Their results…”

“…The chosen flow rate was similar to that reported in previous cadaveric studies [30,31] and falls within the range reported during clinical percutaneous vertebroplasty (PV) which is 1.2 to 12.0 mL/min [32]. However, in clinical PV intermittent injections are typically performed with pauses due to changing of syringes and/or the needle position, which is often retracted backwards due to excessive pressurization [32].…”

“…This may explain why there was no significant difference in the force reported by Reidy et al [31] required to inject bone cement into osteoporotic human vertebrae with and without simulated lytic lesion.…”

“…In their study however, the lesion was filled with soft tumour tissue. It is important to note that the overall flow resistance of the vertebra is mainly a function of the cortical shell, the porosity and the rheological properties of the "fluid" phases (tumour and/or marrow) present within the trabecular network [31]. From a geometrical perspective only, the presence of lytic lesion increases the porosity thus the hydraulic permeability and the overall flow resistance of the vertebra, which decreases the peak injection pressure as evident in the results of this study.…”

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

“…Other complications include embolic events due to marrow, fat, tumor, or cement. The high rate of cement extravasation may be attributed to the tumor tissue behaving as an incompressible spaceoccupying lesion [24]. The presence of the tumor tissue may lead to inadequate fill of the bony defect and suboptimal mechanical stabilization [24].…”