Height restoration and sustainability using bilateral vertebral augmentation systems for vertebral compression fractures: a cadaveric study

Holyoak, Derek T.; Andreshak, Thomas G.; Hopkins, Thomas; Brook, Allan; Frohbergh, Michael; Ong, Kevin

doi:10.1016/j.spinee.2022.06.011

Cited by 6 publications

(14 citation statements)

References 29 publications

(37 reference statements)

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“…There is also a correlation between the efficacy of vertebroplasty and the vertebral height and Cobb angle improvements. It has been reported that vertebroplasty can partially restore the height of the injured vertebra and rectify spinal deformity ( 14 – 16 ). This study's findings demonstrated that PVP reduces the Cobb angle and restores the anterior vertebral height ratio without considering the distribution of bone cement.…”

Section: Discussionmentioning

confidence: 99%

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population

et al. 2022

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ObjectiveThe study aimed to investigate the effect of the type of bone cement distribution on clinical outcomes following percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCF) in the elderly.MethodsRetrospective analysis of 160 patients diagnosed with OVCF who underwent PVP treatment from March 2018 to December 2020. Based on the kind of postoperative bone cement distribution, bone cement was classified as types I, II, III, IV, and V. Visual Analog Scale (VAS), Oswestry Disability Index (ODI), Cobb angle, anterior vertebral height ratio, refracture rate of injured vertebrae, and incidence of adjacent vertebral fractures were compared for the five types before and after three days, and one year of operation.ResultsVAS and ODI at three days and one year postoperative were significantly lower than those preoperative (P < 0.05) for all five distribution types. VAS and ODI for types I, II, and III were lower at one year postoperatively than for types IV and V (P < 0.05). There was no significant difference in Cobb angle and anterior vertebral body height ratio between preoperative and three days postoperative groups (P < 0.05); however, there were significant differences between three days and one-year postoperative and preoperative groups (P < 0.05). Following one year of surgery, the Cobb angle and the anterior vertebral height ratio of types IV and V were significantly different from those of types I, II, and III (P < 0.05), and there was a statistically significant difference between types IV and V (P < 0.05). In terms of the incidence of injured vertebral refractures and adjacent vertebral fractures, the evenly distributed types I, II, and III were significantly lower than the unevenly distributed types IV and V, and the incidence of type V was higher (P < 0.05).ConclusionsThe clinical efficacy of cement distribution following PVP of types I, II, and III is better than that of types IV and V, which can better relieve pain with long-lasting efficacy and minimize the occurrence of refractures of injured vertebrae and adjacent vertebral body fractures.

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Section: Discussionmentioning

confidence: 99%

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population

et al. 2022

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“…Finally, a needle is used to inject cement for additional mechanical stability for all oval-shaped stents, but cement may or may not be required for diamond-shaped stents because they are better able to retain their expanded shape. Jacks are metal 4-sided link-hinge devices that can better maintain VH compared to traditional VP (which cannot fully restore VH due to cement leakage) or KP (which loses some restored VH after balloon removal) (Figure 2(f)) [7,24,25,28,29,[35][36][37]. Assisted by fluoroscopy, a bone biopsy needle is inserted posteriorly through each pedicle, a guidewire is inserted, the needle is removed, and a reamer is passed over the guidewire into the vertebra to ream out space for the implants.…”

Section: Basic Operating Principles Of Vcf Repair Methodsmentioning

confidence: 99%

“…Jacks are metal 4-sided link-hinge devices that can better maintain VH compared to traditional VP (which cannot fully restore VH due to cement leakage) or KP (which loses some restored VH after balloon removal) ( Figure 2(f) ) [ 7 , 24 , 25 , 28 , 29 , 35 – 37 ]. Assisted by fluoroscopy, a bone biopsy needle is inserted posteriorly through each pedicle, a guidewire is inserted, the needle is removed, and a reamer is passed over the guidewire into the vertebra to ream out space for the implants.…”

Section: Basic Operating Principles Of Vcf Repair Methodsmentioning

confidence: 99%

“…All biomechanical studies reviewed here are summarized with details on donor demographics, experimental test protocols, primary biomechanical results, and secondary biomechanical outcomes ( Figure 3 , Table 1 ) [ 14 – 35 , 37 , 38 , 40 , 41 ]. Several trends were noted.…”

Section: General Findings From Biomechanical Studiesmentioning

confidence: 99%

“…Secondly, VP and KP have a longer multidecade history of clinical use than the new stents, jacks, coils, or cubes; therefore, most reports used VP and/or KP as the “gold standard” control [ 21 , 23 – 25 , 27 – 32 , 37 , 38 , 40 , 41 ]. But, some studies optimized a particular repair method under different conditions, but without comparing it to another technique [ 14 , 15 , 17 , 20 , 22 , 26 , 33 – 35 ].…”

Section: General Findings From Biomechanical Studiesmentioning

confidence: 99%

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A 20-Year Review of Biomechanical Experimental Studies on Spine Implants Used for Percutaneous Surgical Repair of Vertebral Compression Fractures

Gajavelli

Gee

Bagheri

et al. 2022

BioMed Research International

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A vertebral compression fracture (VCF) is an injury to a vertebra of the spine affecting the cortical walls and/or middle cancellous section. The most common risk factor for a VCF is osteoporosis, thus predisposing the elderly and postmenopausal women to this injury. Clinical consequences include loss of vertebral height, kyphotic deformity, altered stance, back pain, reduced mobility, reduced abdominal space, and reduced thoracic space, as well as early mortality. To restore vertebral mechanical stability, overall spine function, and patient quality of life, the original percutaneous surgical intervention has been vertebroplasty, whereby bone cement is injected into the affected vertebra. Because vertebroplasty cannot fully restore vertebral height, newer surgical techniques have been developed, such as kyphoplasty, stents, jacks, coils, and cubes. But, relatively few studies have experimentally assessed the biomechanical performance of these newer procedures. This article reviews over 20 years of scientific literature that has experimentally evaluated the biomechanics of percutaneous VCF repair methods. Specifically, this article describes the basic operating principles of the repair methods, the study protocols used to experimentally assess their biomechanical performance, and the actual biomechanical data measured, as well as giving a number of recommendations for future research directions.

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A novel device with pedicular anchorage provides better biomechanical properties than balloon kyphoplasty for the treatment of vertebral compression fractures

Le Huec,

Droulout,

Boue

et al. 2023

J. exp. orthop.

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Purpose To compare the biomechanical behavior of vertebrae with vertebral compression fractures (VCF) treated by a novel system with pedicular anchorage (dowelplasty) versus balloon kyphoplasty. Methods Four cadaveric spines (T12-L5) were harvested, cleaned from soft tissues, and separated into vertebrae. Axial compressive loads were applied to each vertebra until a VCF was generated. Half of the vertebrae (n = 11) were instrumented using the “dowelplasty” system, consisting of a hollow titanium dowel anchored into the pedicle, through which a cannulated titanium nail is inserted and locked and through which cement is injected. The other half (n = 11) were instrumented using balloon kyphoplasty. Axial compressive loads were re-applied to each vertebra until fracture. Fracture load and fracture energy were calculated from load–displacement data for the pre- and post-treatment states. Results Compared to balloon kyphoplasty, dowelplasty granted greater net change in fracture load (373N; 95%CI,-331–1076N) and fracture energy (755Nmm; 95%CI,-563–2072Nmm). A sensitivity analysis was performed without L4 and L5 vertebrae from the dowelplasty group, since the length of the cannulated nails was too short for these vertebrae: compared to balloon kyphoplasty, dowelplasty granted an even greater net change in fracture load (680N; 95%CI,-96–1457N) and fracture energy (1274Nmm; 95%CI,-233–2781Nmm). Conclusion Treating VCFs with dowelplasty grants increased fracture load and fracture energy compared to the pre-treatment state. Furthermore, dowelplasty grants greater improvement in fracture load and fracture energy compared to balloon kyphoplasty, which suggests that dowelplasty may be a good alternative for the treatment of VCF. Level of evidence level IV.

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Height restoration and sustainability using bilateral vertebral augmentation systems for vertebral compression fractures: a cadaveric study

Cited by 6 publications

References 29 publications

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population

Effect of cement distribution type on clinical outcome after percutaneous vertebroplasty for osteoporotic vertebral compression fractures in the aging population

A 20-Year Review of Biomechanical Experimental Studies on Spine Implants Used for Percutaneous Surgical Repair of Vertebral Compression Fractures

A novel device with pedicular anchorage provides better biomechanical properties than balloon kyphoplasty for the treatment of vertebral compression fractures

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