Biomechanical Efficacy of Unipedicular Versus Bipedicular Vertebroplasty for the Management of Osteoporotic Compression Fractures

Tohmeh, Antoine; Mathis, John M.; Fenton, David C.; Levine, Alan M.; Belkoff, Stephen M.

doi:10.1097/00007632-199909010-00004

Cited by 281 publications

(145 citation statements)

References 16 publications

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“…Percutaneous vertebroplasty with bipedicular cement injection is advocated to treat osteoporotic compression fractures in most circumstances [3,28,32]. In patients with vertebral cleft, a unipedicle approach is used because the bone cement generally can distribute into the entire cleft.…”

Section: Discussionmentioning

confidence: 99%

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Revision strategies for complications and failure of vertebroplasties

Yang

Chen

et al. 2008

Eur Spine J

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Percutaneous vertebroplasty is widely discussed in the management of osteoporotic spinal compression fracture, but few reports are available concerning salvage procedures after failure of this technique. We studied 22 percutaneous vertebroplasty patients who required revision surgery upon presentation of new symptoms postoperatively. The indications for revision surgery included recurrent intractable back pain with no response to medical treatment, infectious spondylitis, cement leakage with neurologic deficit, and cement dislodgement and/ or fragmentation. Five patients underwent repeated percutaneous vertebroplasty of the initially cemented vertebrae. Seventeen patients underwent anterior, posterior, or combined anterior and posterior surgery. Four patients required a third surgical procedure because of poor augmentation with cement, subsidence of the anterior bone graft, or pullout of the instrumentation. Finally, four (18%) patients underwent repeat vertebroplasty, two (9%) patients underwent anterior surgery only, one (5%) patient underwent posterior surgery only, and 15 (68%) patients underwent combined anterior and posterior surgery; all but one regained ambulatory status equivalent to that prior to surgery. In conclusion, percutaneous vertebroplasty is a simple and effective, but not risk-or complication-free procedure for the treatment of osteoporotic spinal compression fracture. The spine surgeon should be familiar with varied approaches and techniques for revision surgery. Combined anterior and posterior surgery seems to be the most secure salvage method to treat severely osteoporotic patients in whom percutaneous vertebroplasty initially failed.

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Section: Discussionmentioning

confidence: 99%

“…In patients with vertebral cleft, a unipedicle approach is used because the bone cement generally can distribute into the entire cleft. Using the unipedicle approach saves time and reduces costs and is considered less traumatic for patients [11,32]. This practice is widely used in our institutions.…”

Section: Discussionmentioning

confidence: 99%

Revision strategies for complications and failure of vertebroplasties

Yang

Chen

et al. 2008

Eur Spine J

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“…There was no fluoroscopic guidance, the cement injection was not pressurized and dental cement was used instead of bone cement. The use of unipedicular injection technique has also been found to produce significantly weaker vertebral bodies than bipedicular injections (23). Cement was also prone to anterior leakage out of the fracture site.…”

Section: Discussionmentioning

confidence: 99%

“…As the incidence of vertebral compression fractures continues to rise as our population ages (12), cement augmentation will no doubt be performed more extensively, and more information is needed about this relatively new procedure. Biomechanical studies of vertebroplasty have largely focused on the effects of cement augmentation on the strength and stiffness of single vertebrae, where the overall trend shows increased or maintained vertebral strength (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26), and decreased or maintained stiffness (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) except when a large volume of cement was injected (13). In contrast, multi-level spine models that more closely approximate physiological conditions are limited and more heterogeneous.…”

Section: Introductionmentioning

confidence: 99%

Effects of cement augmentation on the mechanical stability of multilevel spine after vertebral compression fracture

Tan¹,

Wang²,

Pelletier³

et al. 2016

J. Spine Surg.

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Background: Studies on the effects of cement augmentation or vertebroplasty on multi-level spine after vertebral compression fractures are lacking. This paper seeks to establish a 3-vertebrae ovine model to determine the impact of compression fracture on spine biomechanics, and to discover if cement augmentation can restore mechanical stability to fractured spine.Methods: Five lumbar spine segments (L1-L3) were obtained from 5-year-old female Merino sheep.Standardized wedge-compression fractures were generated in each L2 vertebra, and then augmented with polymethyl methacrylate (PMMA) cement mixed with 30% barium sulphate powder. Biomechanical pure moment testing in axial rotation (AR), flexion/extension (FE) and lateral bending (LB) was carried out in the intact, fractured and repaired states. Range of motion (ROM) and neutral zone (NZ) parameters were compared, and plain radiographs taken at every stage.Results: Except for a significant increase in ROM between the intact and fractured states in AR between L1 and L2 (P<0.05), there were no other significant differences in ROM or NZ between the other groups.There was a trend towards an increase in ROM and NZ in all directions after fracture, but this did not reach significance. Normal biomechanics was only minimally restored after augmentation. Conclusions:Results suggest that cement augmentation could not restore mechanical stability of fractured spine. Model-specific factors may have had a role in these findings. Caution should be exercised when applying these results to humans.

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“…It has been demonstrated that PMMA injection into the osteoporotic vertebral body increases its strength and stiffness [24,25]. A study led by Alvarez et al [1] found an increase in incidence of new fractures in the PVP group comparing with the conservative group, even if most of them were not adjacent to augmented vertebra, suggesting that it may represent the natural history of osteoporosis.…”

Section: Discussionmentioning

confidence: 99%

Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

et al. 2011

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Vertebral compression fractures represent a frequent pathology among elderly population, with potentially devastating consequences. More than 20 years have passed since percutaneous vertebroplasty was initially used in the treatment of angiomas, representing nowadays a widely used treatment for osteoporotic vertebral fractures. The authors present a retrospective review of 59 consecutive patients (in total 94 fractured levels) that underwent polymethylmethacrylate percutaneous vertebroplasty for vertebral compression fractures due to senile or secondary osteoporosis. All fractures were free from neurologic involvement and were classified as A1 type according to Magerl classification. All of patients were initially treated conservatively, by application of orthosis that allows immediate deambulation. At control, patients who complained of pain and limitation of daily activities underwent MRI. If presence of marrow signal changes, especially hypertense signal in T2-weighted images was confirmed, percutaneous vertebroplasty procedure was performed (we could call it ''sub-acute'' procedure). A limited group of patients that did not tolerate brace and had an insufficient pain control underwent vertebroplasty ''in acute'', few days after fracture. Immediate post-operative pain reduction and follow-up clinical outcome (estimating quality of life and residual back pain) were evaluated by means of Visual Analogue Scale, SF-36 and Oswestry Disability Index. In the immediate post-operative course a significant pain relief was found in 39 patients (66.1%), moderate pain relief in 17 (28.8%), while 3 (5.1%) did not achieve relevant pain improvement. Pain intensity and life quality was maintained within satisfactory limits after a mean followup of 16 months. In conclusion, percutaneous vertebroplasty is an effective and safe procedure for treating vertebral compression fractures in the elderly. It provides immediate pain relief and allows early mobilization, thus avoiding potentially severe complications related to persistent back pain and prolonged bed rest. When performed by experienced surgeon complication rate is low, representing a safe procedure, able to provide a satisfactory outcome.

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Biomechanical Efficacy of Unipedicular Versus Bipedicular Vertebroplasty for the Management of Osteoporotic Compression Fractures

Abstract: This study suggests that unipedicular and bipedicular injection of cement, as used during percutaneous vertebroplasty, increases acute strength and restores stiffness of vertebral bodies with compression fractures.

Cited by 281 publications

References 16 publications

Revision strategies for complications and failure of vertebroplasties

Revision strategies for complications and failure of vertebroplasties

Effects of cement augmentation on the mechanical stability of multilevel spine after vertebral compression fracture

Vertebroplasty: benefits are more than risks in selected and evidence-based informed patients. A retrospective study of 59 cases

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