A Biomechanical Investigation of Vertebroplasty in Osteoporotic Compression Fractures and in Prophylactic Vertebral Reinforcement

Furtado, Navin; Oakland, Robert J.; Wilcox, Ruth K.; Hall, Richard M.

doi:10.1097/brs.0b013e31811ea2ee

Cited by 60 publications

(49 citation statements)

References 28 publications

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“…Increase in strength for endplate-to-endplate fillings (47% with standard cement and 30% with low-modulus cement) were similar to previous findings for prophylactic vertebroplasty (37% in [20] and 38% in [18]). Other studies reported larger strength and stiffness increases (factor of 2.0-7.8 for stiffness increase and 1.2-11.1 for strength increase in [15]; 174% increase in stiffness and 195% increase in strength in [19]), but cement volumes in these studies were much larger (7.5-10.5 ml in [15] and 5-20 ml in [19]).…”

Section: Discussionsupporting

confidence: 87%

“…Several experimental setups were presented that allowed rotation of the upper loading plate during compression [16][17][18], which produces uniform loading of the specimen and better reproduces in vivo loading conditions than compression between parallel plates. However, in most studies [1,15,16,[18][19][20] the endplates were embedded, whereby experimental uncertainties in the measured displacements and stiffness values were introduced due to the compliance of the embedding material and its contact conditions with the bone. These uncertainties can be minimized by using vertebral body sections [17], which requires the removal of the endplates, but also allows measuring the load transfer near the endplate.…”

Section: Introductionmentioning

confidence: 99%

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The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

et al. 2011

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Purpose Vertebroplasty restores stiffness and strength of fractured vertebral bodies, but alters their stress transfer. This unwanted effect may be reduced by using more compliant cements. However, systematic experimental comparison of structural properties between standard and low-modulus augmentation needs to be done. This study investigated how standard and low-modulus cement augmentation affects apparent stiffness, strength, and endplate pressure distribution of vertebral body sections. Methods Thirty-nine human thoracolumbar vertebral body sections were prepared by removing cortical endplates and posterior elements. The specimens were scanned with a HR-pQCT system and loaded in the elastic range. After augmentation with standard or low-modulus cement they were scanned again and tested in two steps. First, the contact pressure distribution between specimen and loading plates was measured with pressure-sensitive films. Then, they were loaded again in the elastic range and compressed until failure. Apparent stiffness was compared before and after augmentation, whereas apparent strength of augmented specimens was compared to a nonaugmented reference group. Results Vertebral body sections with fillings connecting both endplates were on average 33% stiffer and 47% stronger with standard cement, and 27% stiffer and 30% stronger with low-modulus cement. In contrast, partial fillings showed no significant strengthening for both cements and only a slight stiffness increase (\16%). The averaged endplate pressure above/below the cement was on average 15% lower with low-modulus cement compared to standard cement. Conclusion Augmentation connecting both endplates significantly strengthened and stiffened vertebral body sections also with low-modulus cement. A trend of reduced pressure concentrations above/below the cement was observed with low-modulus cement.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

et al. 2011

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“…The vertebrae were dissected free of soft 16 tissue and disarticulated at the intervertebral disc. The posterior and transverse processes 17 were detached whilst keeping the neural arch intact per the protocol used previously 18 (Furtado et al, 2007). Between experimental stages, the vertebrae were wrapped in tissue 19 soaked with purified water, placed in sealed plastic bags, and kept frozen at -20°C until 24 20 hours prior to the next stage.…”

Section: Methods 8 21 Specimen Preparation and Handlingmentioning

confidence: 99%

“…vBMD and BV/TV were estimated from a 3 cylindrical volume of interest (= 60% of the anterior-posterior length; h= 80% of the 4 height) within the trabecular bone in each VB (Furtado et al, 2007), with BV/TV calculated 5 using a single value threshold based on an iterative user-independent selection method 6 (Ridler and Calvard, 1978). 7…”

Section: Micro Computed Tomography (Microct) 23mentioning

confidence: 99%

Biomechanics of low-modulus and standard acrylic bone cements in simulated vertebroplasty: A human ex vivo study

Holub

López

Borse

et al. 2015

Journal of Biomechanics

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The high stiffness of bone cements used in vertebroplasty has been hypothesized to contribute to the propensity of adjacent vertebral fractures after treatment. Therefore, new lowmodulus cements have been developed; however, there are currently no studies assessing the biomechanical aspects of vertebroplasty with these cements in an ex vivo non-prophylactic model. In this study, we induced wedge fractures through eccentric uniaxial compression to single wholevertebrae, before and after augmentation with either standard or low-modulus cement. Compressive strength and stiffness of individual vertebrae were measured, on 19 samples from metastatic spines and 20 samples from elderly, osteopenic spines. While both cement types increased the strength of both the metastatic (+34% and +63% for standard and low-modulus cement, respectively) and the elderly vertebrae (+ 303% and +113%, respectively), none of them restored the initial stiffness of metastatic specimens (-51% and -46%, respectively). Furthermore, low-modulus cement gave a lower total stiffness (-13%) of elderly specimens whereas standard cement increased it above initial levels (+17%). Results show that vertebroplasty with low-modulus cement could provide restoration of the initial stiffness while increasing the strength of fractured elderly vertebrae and hence represent a treatment modality which is closer to pre-augmented behaviour. Also, this study indicates that stiffness-modified cement needs to be optimized for patient/pathology specific treatment. The high stiffness of bone cements used in vertebroplasty has been hypothesized to contribute to the propensity 2 of adjacent vertebral fractures after treatment. Therefore, new low-modulus cements have been developed; 3 however, there are currently no studies assessing the biomechanical aspects of vertebroplasty with these 4 cements in an ex vivo non-prophylactic model. In this study, we induced wedge fractures through eccentric 5 uniaxial compression to single whole-vertebrae, before and after augmentation with either standard or low-6 modulus cement. Compressive strength and stiffness of individual vertebrae were measured, on 19 samples 7 from metastatic spines and 20 samples from elderly, osteopenic spines. While both cement types increased the 8 strength of both the metastatic (+34% and +63% for standard and low-modulus cement, respectively) and the 9 elderly vertebrae (+ 303% and +113%, respectively), none of them restored the initial stiffness of metastatic 10 specimens (-51% and -46%, respectively). Furthermore, low-modulus cement gave a lower total stiffness (-11 13%) of elderly specimens whereas standard cement increased it above initial levels (+17%). Results show that 12 vertebroplasty with low-modulus cement could provide restoration of the initial stiffness while increasing the 13 strength of fractured elderly vertebrae and hence represent a treatment modality which is closer to pre-14 augmented behaviour. Also, this study indicates that stiffness-modified cement needs to be optimized ...

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“…3. Because a low risk of adjacent vertebral fractures is described for vertebral augmentation techniques (generally for vertebroplasty) with PMMA cement [Gerztbein et al, 1994;Tseng et al, 2009], we prefer to not overfill the fractured vertebra keeping this risk to the minimum: reported clinical studies have shown that even "insufficient" filling of vertebral bodies during a vertebroplasty can lead to a successful outcomes in pain reduction, and stiffening and stabilizing of the fractured vertebrae [Luo et al, 2007;Furtado et al, 2007;Oakland et al, 2009]. The mechanism for adjacent vertebral fractures is still unclear, but from experimental and computational studies, it appears that vertebroplasty changes the mechanical loading in adjacent vertebrae because of excessive cement rigidity of treated vertebra [Baroud et al, 2006;Berlemann et al, 2002].…”

Section: Traumatic Vcfs: Tips and Tricksmentioning

confidence: 99%

Balloon-Kyphoplasty for Vertebral Compression Fractures

Arpino¹,

Nina²

2012

Explicative Cases of Controversial Issues in Neurosurgery

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A Biomechanical Investigation of Vertebroplasty in Osteoporotic Compression Fractures and in Prophylactic Vertebral Reinforcement

Cited by 60 publications

References 28 publications

The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

Biomechanics of low-modulus and standard acrylic bone cements in simulated vertebroplasty: A human ex vivo study

Balloon-Kyphoplasty for Vertebral Compression Fractures

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