Long‐term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty

Grados, Franck; Depriester, C.; Cayrolle, G.; Hardy, Niall; Deramond, H.; Fardellone, Patrice

doi:10.1093/rheumatology/39.12.1410

Cited by 562 publications

(103 citation statements)

References 11 publications

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“…In the literature, a significant reduction of pain after percutaneous vertebroplasty is reported in nearly all studies [7,9,[11][12][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29]. Our series confirms this reduction of pain.…”

Section: Discussionsupporting

confidence: 83%

“…Long-term effects of bone cement, and especially the potential risk of new fractures of adjacent vertebrae due to the immobilized vertebral segments, have to be analyzed in prospective randomized trials. Retrospective findings are promising and do not show any major negative effects [17,21,25,27].…”

Section: Discussionmentioning

confidence: 91%

“…Changes in bone matrix structural factors lead to microdamage of the bone and therefore especially to fractured trabeculae [30]. It might therefore be, that microfractures already generate pain and that bone-cement leads to a stabilization and immobilization of the vertebral [7,9,[11][12][13][14][15][16][19][20][21][22][23][24][25][26][27][28][29] body with a subsequent reduction of pain [30]. Osteoporosis and the osteoporotic vertebral body fracture do not only affect one part of the vertebral body, but also the complete vertebral body.…”

Section: Discussionmentioning

confidence: 99%

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CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures

et al. 2005

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The purpose of this study was to determine the efficacy and safety of CT-guided percutaneous vertebroplasty in the treatment of vertebral compression fractures. The primary objectives were pain reduction and bone-cement leakage during a long-term follow-up in patients with osteoporotic vertebral compression fractures. CT-guided percutaneous vertebroplasty was carried out in 61 patients (mean age 71.4 years; range 42-83; female ratio: 73.8%) with vertebral compression fractures. Treatment was carried out on an outpatient basis. Pain, bone-cement leakage and complications were monitored and recorded. The mean follow-up time was 19.8 months (range 3-52). Paired comparison procedures were used for the analysis of the results, which showed that all patients had a significant reduction of pain. The mean visual-analogue scale (VAS) before treatment was 8.8 points (range 6.5-9.8 points). The mean VAS score after treatment was significantly reduced to 2.6 points (range 1.5-4.1 points; p<0.01). No clinical or neurological complications were documented. Minor and asymptomatic bone-cement leakage was observed in 54% of the cases. Percutaneous vertebroplasty is an efficient and safe interventional procedure which rapidly improves the mobility and quality of life of patients with vertebral compression fractures. CT-guidance is a reasonable upgrade in the treatment procedure which reduces the amount of bone-cement leakage.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures

et al. 2005

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“…This is a consequence of the much higher cement volume fraction than bone volume fraction (0-20% for vertebral cancellous bone) 16,21 , but the lack of bonding between bone and PMMA also results in a simple rule of mixture not being applicable for predicting the mechanical response of the composite 20,22 . The mismatch of apparent properties between healthy cancellous bone and the bone−cement composite has raised concerns, since adjacent vertebral fractures occurring shortly after vertebroplasty have been reported [23][24][25] . Other causes of fractures may be related to bulging of the adjacent endplates, higher volume of injected cement, and cement leakage into the disc [26][27][28][29] .…”

Section: Introductionmentioning

confidence: 99%

Compressive mechanical properties and cytocompatibility of bone-compliant, linoleic acid-modified bone cement in a bovine model

López

Mestres

Ott

et al. 2014

Journal of the Mechanical Behavior of Biomedical Materials

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PostprintThis is the accepted version of a paper published in Journal of The Mechanical Behavior of Biomedical Materials. This paper has been peer-reviewed but does not include the final publisher proofcorrections or journal pagination. Citation for the original published paper (version of record):López, A., Mestres, G., Karlsson Ott, M., Engqvist, H., Ferguson, S. et al. (2014) Compressive mechanical properties and cytocompatibility of bone-compliant, linoleic acidmodified bone cement in a bovine model. Journal of The Mechanical AbstractAdjacent vertebral fractures are a common complication experienced by osteoporosis patients shortly after vertebroplasty. Whether these fractures are due to the bone cement properties, the cement filling characteristics or to the natural course of the disease is still unclear. However, some data suggests that such fractures might occur because of an imbalance in the load distribution due to a mismatch between the elastic modulus (E) of the bonecement composite, and that of the vertebral cancellous bone. In this study, the properties of bone-compliant linoleic acid-modified bone cements were assessed using a bovine vertebroplasty model. Two groups of specimens (cementonly and bone-cement composites), and four subgroups comprising bone cements with elastic moduli in the range of 870-3500 MPa were tested to failure in uniaxial compression. In addition, monomer release as well as time and concentration-dependent cytocompatibility was assessed through the cement extracts using a Saos-2 cell model.Composites augmented with bone-compliant cements exhibited a reduction in E despite of their relatively high bone volume fraction (BVF). Moreover, a significant positive correlation between the BVF and E for the composites augmented with 870 MPa modulus cements was found. This was attributed to the increased relative contribution of the bone to the mechanical properties of the composites with a decrease in E of the bone cement. The use of linoleic acid reduced monomer conversion resulting in six times more monomer released after 24 hours. However, the cytocompatibility of the bone-compliant cements was comparable to that of the unmodified cements after the extracts were diluted four times. This study represents an important step towards introducing viable bone-compliant bone cements into vertebroplasty practice.

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“…Typically, the cements are prepared directly prior to injection by mixing powder [polymethylmethacrylate (PMMA), X-ray contrast agent (e.g., barium sulfate)] and liquid [methylmethacrylate monomer (MMA)] to form a fluid mixture. Percutaneous vertebroplasty, comprising an injection of PMMA into vertebral bodies leads to immediate pain relief in 80-90% of patients [8,10,16]. However, cement leakage is a common occurrence and represents the main complication risk for vertebroplasty [14].…”

Section: Introductionmentioning

confidence: 99%

Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements

Böger¹,

Wheeler²,

Schenk³

et al. 2009

Eur Spine J

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Percutaneous vertebroplasty, comprising an injection of polymethylmethacrylate (PMMA) into vertebral bodies, is a practical procedure for the stabilization of osteoporotic compression fractures as well as other weakening lesions. Cement leakage is considered to be one of the major and most severe complications during percutaneous vertebroplasty. The viscosity of the material plays a key role in this context. In order to enhance the safety for the patient, a rheometer system was developed to measure the cement viscosity intraoperatively. For this development, it is of great importance to know the proper viscosity to start the procedure determined by experienced surgeons and the relation between the time period when different injection devices are used and the cement viscosity. The purpose of the study was to investigate the viscosity ranges for different injection systems during conventional vertebroplasty. Clinically observed viscosity values and related time periods showed high scattering. In order to get a better understanding of the clinical observations, cement viscosity during hardening at different ambient temperatures and by simulation of the body temperature was investigated in vitro. It could be concluded, that the direct viscosity assessment with a rheometer during vertebroplasty can help clinicians to define a lower threshold viscosity and thereby decrease the risk of leakage and make adjustments to their injection technique in real time. Secondly, the acceleration in hardening of PMMA-based cements at body temperature can be useful in minimizing leakages by addressing them with a short injection break.

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Long‐term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty

Cited by 562 publications

References 11 publications

CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures

CT-guided percutaneous vertebroplasty in the therapy of vertebral compression fractures

Compressive mechanical properties and cytocompatibility of bone-compliant, linoleic acid-modified bone cement in a bovine model

Clinical investigations of polymethylmethacrylate cement viscosity during vertebroplasty and related in vitro measurements

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