An Evaluation of Fracture Stabilization Comparing Kyphoplasty and Titanium Mesh Repair Techniques for Vertebral Compression Fractures

Ghofrani, Hossein Ardeschir; Nunn, Thomas; Robertson, Claire; Mahar, Andrew; Lee, Yu-Po; Garfin, Steven R.

doi:10.1097/brs.0b013e3181d260bf

Cited by 22 publications

(30 citation statements)

References 33 publications

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“…An experimental study showed no negative nonunion rates for osteoporotic fracture healing (conservative) but nevertheless observed a decreased quantity and quality of callus mineralization [40]. Another problem following cement application is the changed biomechanical behavior (increased stiffness) of the vertebral body which in turn promotes other complications as adjacent fracture development [5, 6, 21–23, 41]. Adjacent vertebral fractures are the most common complications reported in the literature with up to 8% after vertebroplasty and 8 to 26% after kyphoplasty [19, 42–44].…”

Section: Discussionmentioning

confidence: 99%

“…First-step biomechanical trials performed by Upasani et al [27] comparing the titanium mesh cages with cement application and the commonly used balloon kyphoplasty showed significant greater height maintenance and significant less cement amounts in the titanium mesh group. Second step biomechanical studies by Ghofrani et al [21] compared the titanium mesh cages without cement application versus kyphoplasty in human spine cadavers and revealed similar results. One single third step studies showed that VCF stabilization combining cement application and the titanium mesh cages are effective in terms of fracture reduction with low complication rates in a clinical setting [14].…”

Section: Introductionmentioning

confidence: 88%

“…Another problem with cement based treatment strategies is the nonabsorbality of the required PMMA cement leading to a life-long rigid implant which may support adjacent vertebral fractures [12, 21–23]. Until now it is not known as to whether the extensive filling of cement in a vertebral body has an adverse effect on bony healing [24].…”

Section: Introductionmentioning

confidence: 99%

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Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

Eschler

Ender

Ulmar

et al. 2014

BioMed Research International

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Introduction. Vertebral compression fractures (VCFs) affect 20% of people over the age of 70 with increasing incidence. Kypho-/vertebroplasty as standard operative procedures are associated with limitations like cement leakage, limited reduction capabilities, and risk for adjacent fractures. To address these shortcomings, we introduce a new minimal invasive cementless VCF fixation technique. Methods. Four patients (72.3 years, range 70–76) with VCFs type AO/Müller A1.3 and concomitant osteoporosis were treated by minimal invasive transpedicular placement of two intervertebral mesh cages for fracture reduction and maintenance. Follow-up included functional/radiological assessment and clinical scores and averaged 27.7 months (24–28). Results. Endplate reduction was achieved in all cases (mean surgery time: 28.5 minutes). Kyphotic (KA) and Cobb angle revealed considerable improvements postoperatively (KA 14.5° to 10.7°/Cobb 10.1° to 8.3°). Slight loss of vertebral reduction (KA: 12.6°) and segment rekyphosis (Cobb: 10.7°) were observed for final follow-up. Pain improved from 8.8 to 2.8 (visual analogue scale). All cases showed signs of bony healing. No perioperative complications and no adjacent fractures occurred. Conclusion. Preliminary results in a small, selected patient collective indicate the ability of bony healing for osteoporotic VCFs. Cementless fixation using intravertebral titanium mesh cages revealed substantial pain relief, adequate reduction, and reduction maintenance without complications. Trial registration number is DRKS00005657, German Clinical Trials Register (DKRS).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

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Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

Eschler

Ender

Ulmar

et al. 2014

BioMed Research International

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“…This is a titanium mesh cage that also offers the possibility of minimally invasive percutaneous stabilization of the above-described spinal injuries [14] [15].…”

Section: Discussionmentioning

confidence: 99%

“…They represent a new percutaneous stabilization method of osteoporotic throracolumbar vertebral compression fractures [14] [15].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous Stabilization System Osseofix® for Treatment of Osteoporotic Vertebral Compression Fractures - Clinical and Radiological Results after 12 Months

et al. 2013

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Study DesignA prospective consecutive cohort study (follow-up study).ObjectiveOur study investigated whether implantation of an expandable titanium mesh cage (Osseofix®) is a successful and safe minimally invasive therapy for osteoporotic vertebral compression fractures (VCF). Our experiences, clinical and radiological findings after 12 months follow-up are presented. Kypho- and vertebroplasty are well-established minimally invasive procedures for the treatment of osteoporotic VCF. The main complications associated with both procedures are uncontrolled bone cement leakage. Therefore a suitable alternative has been investigated.MethodsDuring June 2010 to May 2011 24 patients were included with 32 osteoporotic VCF (T6 to L4). All of them were stabilized with the Osseofix® system. Preinterventionally we performed X-ray, MRI, and bone density measurements (DXA). Clinical and radiological results were evaluated preop., postop. and after 12 months postop. based on the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS), X-ray (Beck Index, Cobb-angle) and CT.ResultsThere was a significant improvement in the mean ODI (70,6% to 30,1%) as well as a significant reduction in pain intensity (VAS) (7,7 to 1,4) after 12 month. The mean kyphotic angle according to Cobb showed significant improvements (11,7° to 10,4°) after 12 months. Postinterventional imaging showed only one case of loss of height in a stabilized vertebral body (3.1%). We saw no changes in posterior vertebral wall or adjacent fractures. Except for one pronounced postoperative hematoma we saw no surgical complications including no cement leakage.ConclusionsStabilization of symptomatic osteoporotic VCF with Osseofix® system is a safe and effective procedure, even in fractures with posterior wall involvement. The clinical mid-term results are good at a very low complication rate. The Osseofix® system is an interesting alternative to the established procedures of cement augmentation.

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Fabrication of reactive poly(vinyl alcohol) membranes for prevention of bone cement leakage

2014

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Leakage of bone cement into the spinal canal has been reported to cause many adverse effects. In this study, we designed an implantable balloon kyphoplasty material that avoids cement leakage through the formation of covalent bonds with the bone cement. For this purpose, glycidyl methacrylate (GMA) was used as a reactive functional group attached to the poly(vinyl alcohol) (PVA) membrane. The prepared membrane adhered to poly(methyl methacrylate) (PMMA)-based bone cements within 10 min, which is the time required for PMMA polymerization in the bone cement. The bonding strength between the GMA-PVA membrane and the PMMA-based bone cement was higher than that for the original PVA membrane, likely because vinyl bonds form between the surface of the GMA-PVA membrane and the bone cement. Since the GMA-PVA membrane adhered firmly to the PMMA-based bone cement, the membrane was able to completely cover the PMMA-based bone cement.

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An Evaluation of Fracture Stabilization Comparing Kyphoplasty and Titanium Mesh Repair Techniques for Vertebral Compression Fractures

Cited by 22 publications

References 33 publications

Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

Cementless Fixation of Osteoporotic VCFs Using Titanium Mesh Implants (OsseoFix): Preliminary Results

Percutaneous Stabilization System Osseofix® for Treatment of Osteoporotic Vertebral Compression Fractures - Clinical and Radiological Results after 12 Months

Fabrication of reactive poly(vinyl alcohol) membranes for prevention of bone cement leakage

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