An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty

Belkoff, Stephen M.; Maroney, Marcee; Fenton, David C.; Mathis, John M.

doi:10.1016/s8756-3282(99)00128-3

Cited by 153 publications

(74 citation statements)

References 15 publications

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“…Several factors are reported to cause cage subsidence in intervertebral fusions including LIF: reduced bone quality 12,13) , older age 13) , multilevel procedures 1,14) , narrow cage 1,2) , and use of rhBMP-2 15) . However, the abovementioned reports mixed two types of cage subsidence (intraoperative injury and postoperative spontaneous settling).…”

Section: Discussionmentioning

confidence: 99%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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Abstract:Introduction: Few studies have investigated the influence of cage subsidence patterns (intraoperative endplate injury or late-onset cage settling) on bony fusion and clinical outcomes in lateral interbody fusion (LIF). This retrospective study was performed to compare the fusion rate and clinical outcomes of cage subsidence patterns in LIF at one year after surgery.Methods: Participants included 93 patients (aged 69.0±0.8 years; 184 segments) who underwent LIF with bilateral pedicle screw fixation. All segments were evaluated by computed tomography and classified into three groups: Segment E (intraoperative endplate injury, identified immediately postoperatively); Segment S (late-onset settling, identified at 3 months or later); or Segment N (no subsidence). We compared patient characteristics, surgical parameters and fusion status at 1 year for the three subsidence groups. Patients were classified into four groups: Group E (at least one Segment E), Group S (at least one Segment S), Group ES (both Segments E and S), or Group N (Segment N alone). Visual analog scales (VASs) and the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) were compared for the four patient groups.Results: 184 segments were classified: 31 as Segment E (16.8%), 21 as Segment S (11.4%), and 132 as Segment N (71.7%). Segment E demonstrated significantly lower bone mineral density (-1.7 SD of T-score, p=0.003). Segment S demonstrated a significantly higher rate of polyetheretherketone (PEEK) cages (100%, p=0.03) and a significantly lower fusion rate (23.8%, p=0.01). There were no significant differences in VAS or in any of the JOABPEQ domains among the four patient groups.Conclusions: Intraoperative endplate injury was significantly related to bone quality, and late-onset settling was related to PEEK cages. Late-onset settling demonstrated a worse fusion rate. However, there were no significant differences in clinical outcomes among the subsidence patterns.

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Section: Discussionmentioning

confidence: 99%

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Satake

Kanemura

Nakashima

et al. 2017

Spine Surg Relat Res

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“…This minimally invasive technique brings great benefit to patients and leads to immediate and lasting pain relief in 80-93% of patients [16]. The analgetic mechanism is not fully explored; besides the mechanical stabilization of the fracture also the destruction of nerve fibers by thermal and/ or toxic effect at polymerization of the PMMA cement is discussed [6,22]. The biomechanical effect in terms of increased stiffness and strength has been documented in various studies and relates directly to the volume of injected cement [25].…”

Section: Introductionmentioning

confidence: 99%

The effect of pulsed jet lavage in vertebroplasty on injection forces of PMMA bone cement: an animal study

Böger¹,

Benneker

Krebs³

et al. 2009

Eur Spine J

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Percutaneous vertebroplasty, comprising of the injection of polymethylmethacrylate (PMMA) into vertebral bodies, is an efficient procedure to stabilize osteoporotic compression fractures as well as other weakening lesions. Besides fat embolism, cement leakage is considered to be one of the major and most severe complications during percutaneous vertebroplasty. The viscosity of the PMMA during injection plays a key role in this context. It was shown in vitro that the best way to lower the risk of cement leakage is to inject the cement at higher viscosity, which is requires high injection forces. Injection forces can be reduced by applying a newly developed lavage technique as it was shown in vitro using human cadaver vertebrae. The purpose of this study was to prove the in vitro results in an in vivo model. The investigation was incorporated in an animal study that was performed to evaluate the cardiovascular reaction on cement augmentation using the lavage technique. Injection forces were measured with instrumentation for 1 cc syringes, additionally acquiring plunger displacement. Averaged injection forces measured, ranged from 12 to 130 N and from 28 to 140 N for the lavage group and the control group, respectively. Normalized injection forces (by viscosity and injection speed)showed a trend to be lower for the lavage group in comparison to the control group (P = 0.073). In conclusion, the clinical relevance on the investigated lavage technique concerning lowering injection forces was only shown by trend in the performed animal study. However, it might well be that the effect is more pronounced for osteoporotic vertebral bodies.

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“…Although there is a varying consensus among treating physicians, surgical fixation of a traumatic fracture of the thoracic or lumbar spine is considered necessary if axial and rotational stability is severely impaired or if a neurologic deficit is present or imminent. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures [3,4]. It is a relatively easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited.…”

Section: Introductionmentioning

confidence: 99%

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

Afzal¹,

Saleem²,

Dhar³

2008

Eur Spine J

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To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The postoperative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit.

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An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty

Cited by 153 publications

References 15 publications

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

Cage subsidence in lateral interbody fusion with transpsoas approach: intraoperative endplate injury or late-onset settling

The effect of pulsed jet lavage in vertebroplasty on injection forces of PMMA bone cement: an animal study

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

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