Einfluss der Wirbelkörpersteifigkeit vor und nach Vertebroplastik auf den intradiskalen Druck / Effect of Vertebral Body Stiffness Before and After Vertebroplasty on Intradiscal pressure

Rohlmann, A.; Zander, Thomas; Jony,; Weber, U.; Bergmann, G.

doi:10.1515/bmt.2005.022

Cited by 11 publications

(9 citation statements)

References 12 publications

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“…One of them was adjacent vertebral compression fractures, which might be caused by outward factors including stress transferred from a treated vertebra with PMMA, poor sagittal balance and compensation of the upper body shifting after pain relief, intradiscal cement leakage, cement configuration and an infused volume in the vertebral body as well as an inward resistant factor, i.e. bone density6,7,13-17. The strength of PMMA was eight to forty times higher than that of the osteoporotic vertebra.…”

Section: Discussionmentioning

confidence: 99%

“…The cement that leaks into the spinal canal or neural canal can cause stenosis, and a high polymerization temperature can cause severe thermal injury to the nerve tissue3,4. In addition, the vertebral body strengthened with the cement itself might induce an adjacent vertebral compression fracture5-7. To reduce these complications from vertebroplasty, there have been several reports on the ideal mechanical properties of the cement for vertebroplasty, including methods for infusing the cement with high viscosity and the use of cement with less strength and a lower polymerization temperature8-10.…”

Section: Introductionmentioning

confidence: 99%

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Mechanical Properties of Blood-Mixed Polymethylmetacrylate in Percutaneous Vertebroplasty

Ahn¹,

Lee²,

Choi³

et al. 2009

Asian Spine J

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Study DesignMechanical study of polymethylmetacrylate (PMMA) mixed with blood as a filler.PurposeAn attempt was made to modify the properties of PMMA to make it more suitable for percutaneous vertebroplasty (PVP).Overview of LiteratureThe expected mechanical changes by adding a filler into PMMA included decreasing the Young's modulus, polymerization temperature and setting time. These changes in PMMA were considered to be more suitable and adaptable conditions in PVP for an osteoporotic vertebral compression fracture.MethodsPorous PMMA were produced by mixing 2 ml (B2), 4 ml (B4) and 6 ml (B6) of blood as a filler with 20 g of regular PMMA. The mechanical properties were examined and compared with regular PMMA(R) in view of the Young's modulus, polymerization temperature, setting time and optimal passing-time within an injectable viscosity (20-50 N-needed) through a 2.8 mm-diameter cement-filler tube. The porosity was examined using microcomputed tomography.ResultsThe Young's modulus decreased from 919.5 MPa (R) to 701.0 MPa (B2), 693.5 Mpa (B4), and 545.6 MPa (B6). The polymerization temperature decreased from 74.2℃ (R) to 59.8℃ (B2), 54.2℃ (B4) and 47.5℃ (B6). The setting time decreased from 1,065 seconds (R) to 624 seconds (B2), 678 seconds (B4), and 606 seconds (B6), and the optimal passing-time decreased from 75.6 seconds (R) to 46.6 seconds (B2), 65.0 seconds (B4), and 79.0 seconds (B6). The porosity increased from 4.2% (R) to 27.6% (B2), 27.5% (B4) and 29.5% (B6). A homogenous microstructure with very fine pores was observed in all blood-mixed PMMAs.ConclusionsBlood is an excellent filler for PMMA. Group B6 showed more suitable mechanical properties, including a lower elastic modulus due to the higher porosity, less heating and retarded optimal passing-time by the serum barrier, which reduced the level of friction between PMMA and a cement-filler tube.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Mechanical Properties of Blood-Mixed Polymethylmetacrylate in Percutaneous Vertebroplasty

Ahn¹,

Lee²,

Choi³

et al. 2009

Asian Spine J

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“…Osteoporosis related fractures of the spinal column lead to pain and functional limitations, or even resulting in confinement to bed [1]. Due to the commonly wedge-shaped collapsing pattern of osteoporotic vertebral compression fractures (VCF) imbalanced kyphosis may occur, leading to loss of sagittal balance, chronic pain, and potentially resulting in decreased lung capacity and gastro-intestinal dysfunction [2, 3].…”

Section: Introductionmentioning

confidence: 99%

“…According to the treatment guidelines of Anselmetti et al surgical treatment should be performed, if conservative treatment fails [5]. If the vertebral body is already deformed, kyphoplasty aims at correction of the vertebral shape in order to reduce pain and disability and to restore sagittal balance [1, 4–7].…”

Section: Introductionmentioning

confidence: 99%

“…PMMA generates significant heat during the exothermic hardening process and it lacks biologic integration and healing due to induction of chemical or thermal necrosis within the vertebral body [9]. Moreover, the elastic modulus of PMMA exceeds the one of cancellous bone up to the 30-fold [1, 9–11]. This mismatch of mechanical properties might contribute to significantly higher onset of vertebral fractures adjacent to augmented levels [4, 12].…”

Section: Introductionmentioning

confidence: 99%

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Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement

Meyer

Gaalen

Leschinger

et al. 2019

BioMed Research International

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If conservative treatment of osteoporotic vertebral compression fractures fails, vertebro- or kyphoplasty is indicated. Usually, polymethylmethacrylate cement (PMMA) is applied coming along with many disadvantageous features. Aluminum-free glass-polyalkenoate cement (GPC) appears to be a benefit alternative material. This study aimed at comparing the mean stress values in human vertebrae after kyphoplasty with PMMA and GPC (IlluminOss™) at hand of a finite element analysis. Three models were created performing kyphoplasty using PMMA or IlluminOss™, respectively, at two native, human lumbar vertebrae (L4) while one remains intact. Finite element analysis was performed using CT-scans of every vertebra. Moreover the PMMA-treated vertebra was used as a model as analyses were executed using material data of PMMA and of GPC. The unimpaired, spongious bone showed potentials of 0.25 MPa maximally. After augmentation stress levels showed fivefold increase, rising from externally to internally, revealing stress peaks at the ventral border of the spinal canal. At central areas of cement 1 MPa is measured in both types of cement. Around these central areas the von Mises stress decreased about 25-50% (0.5-0.75 MPa). If workload of 500 N was applied, the stress appeared to be more centralized at the IlluminOss™-model, similar to the unimpaired. Considering the endplates the GPC model also closely resembles the unimpaired. Comparing the PMMA-treated vertebral body and the GPC-simulation, there is an obvious difference. While the PMMA-treated model showed a central stress peak of 5 MPa, the GPC-simulation of the same vertebral body presents lower stress of 1.2-2.5 MPa. Finite element analysis showed that IlluminOss™ (GPC), used in kyphoplasty of vertebral bodies, creates lower level stress and strain compared to standardly used PMMA, leading to lower stress concentrations on the cranial and caudal vertebral surface especially. GPC appears to own advantageous biological and clinical relevant features.

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Vertebroplastie und Kyphoplastie bei osteoporotischen Wirbelkörperfrakturen: Gesicherte Kenntnisse, offene Fragen

Bohndorf¹,

Fessl²

2006

Radiologe

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Cementoplasty, performed either as percutaneous vertebroplasty or kyphoplasty, has become well established as an effective technique to treat painful vertebral body fractures. It has low complication rates, is successful in alleviating pain, and improves the patients' mobility and quality of life. A series of questions remain open though or are the subject of controversial debate; for example, the results of several biomechanical studies are in part contradictory. Clinical data on subsequent fractures are also still inadequate, although the majority of studies show no elevated rate of subsequent fractures following treatment with cementoplasty in comparison to the natural course in patients with osteoporotic fractures. Kyphoplasty has the advantage of being able to restore the vertebral body height or reduce the kyphosis angle without leading to different clinical outcomes in comparison to vertebroplasty. Biomechanical considerations on whether restoration of the vertebral body's normal shape could reduce the rate of subsequent fractures still need scientific substantiation. Both surgical methods are employed in our clinic. Kyphoplasty seems to us to be indicated when the height of the anterior portion of the vertebral body is reduced by one-third compared to the norm or a kyphosis angle of more than 15-20 degrees is present. The goals of therapy are restoring the shape and reducing the kyphosis angle. This can only succeed, however, in fractures that are not older than 3 weeks. In all other cases vertebroplasty is performed.

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Einfluss der Wirbelkörpersteifigkeit vor und nach Vertebroplastik auf den intradiskalen Druck / Effect of Vertebral Body Stiffness Before and After Vertebroplasty on Intradiscal pressure

Cited by 11 publications

References 12 publications

Mechanical Properties of Blood-Mixed Polymethylmetacrylate in Percutaneous Vertebroplasty

Mechanical Properties of Blood-Mixed Polymethylmetacrylate in Percutaneous Vertebroplasty

Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement

Vertebroplastie und Kyphoplastie bei osteoporotischen Wirbelkörperfrakturen: Gesicherte Kenntnisse, offene Fragen

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