Percutaneous Injection of Strontium Containing Hydroxyapatite versus Polymethacrylate Plus Short-Segment Pedicle Screw Fixation for Traumatic A2- and A3/AO-Type Fractures in Adults

Abstract

Introduction. Polymethacrylate (PMMA) is commonly used in vertebroplasty and balloon kyphoplasty, but its use has been associated with complications. This study tests three hypotheses: (1) whether strontium hydroxyapatite (Sr-HA) is equivalent to PMMA for restoring thoracolumbar vertebral body fractures, (2) whether the incidence of PMMA leakage is similar to that of Sr-HA leakage, and (3) whether Sr-HAis is resorbed and substituted by new vertebral bone. Materials and Methods. Two age- and sex-matched groups received short percutaneous pedicle screw fixation plus PEEK implant (Kiva, VCF Treatment System, Benvenue Medical, Santa Clara, CA, USA) filled with either Sr-HA (Group A) or PMMA (Group B) after A2- and A3/AO-type thoracolumbar vertebral body fractures. The Visual Analog Scale (VAS) score and imaging parameters, which included segmental kyphosis angle (SKA), vertebral body height ratios (VBHr), spinal canal encroachment (SCE), bone cement leakage, and Sr-HA resorption, were compared between the two groups. Results. The average follow-up was 28 months. No differences in VAS scores between Groups A and B were observed at baseline. Baseline back pain in both groups improved significantly three months postoperatively. Anterior, middle, and posterior VBHr did not differ between the two groups at any time point. SKA was improved insignificantly in both groups. SCE decreased insignificantly in both groups on 12-month follow-up using computed tomography (CT). PMMA leakage was observed in one patient, while no Sr-HA paste leakages occurred. Sr-HA resorption and replacement with vertebral bone were observed, and no new fractures were observed. Conclusions. As all hypotheses were confirmed, the authors recommend the use of Sr-HA instead of PMMA in traumatic spine fractures, although more patients and longer follow-up will be needed to strengthen these results. This trial is registered with NCT03431519.

The Influence of Strontium on Bone Tissue Metabolism and Its Application in Osteoporosis Treatment

“…Sr-HA was resorbed and replaced with vertebral bone, and no new fractures were observed. Cheung et al and Izci et al also obtained favorable in vivo results [ 69 , 70 , 71 ].…”

Can strontium replace calcium in bioactive materials for dental applications?

“…12 In vivo Sr-HA has been successfully used for improving the posterolateral fusion rate in ovariectomized rats 13 as well as for restoring thoracolumbar vertebral body fractures. 14 The Sr doped HA has also been used to coat titanium implants to enhance osseointegration. 15,16 These material types are tailormade for specific applications in orthopedic surgery to modulate bone repair.…”

“…A 10% doped variant has been demonstrated in vitro to significantly increase levels of proliferation, alkaline phosphatase activity and collagen type I whilst down‐regulating the production of interleukin‐6, indicating a potential beneficial effect of strontium in the treatment of bone lesions and defects in the presence of osteoporotic bone 12 . In vivo Sr‐HA has been successfully used for improving the posterolateral fusion rate in ovariectomized rats 13 as well as for restoring thoracolumbar vertebral body fractures 14 . The Sr doped HA has also been used to coat titanium implants to enhance osseointegration 15,16 .…”

Investigation of optical reflectance from different animal vertebra along the fixation trajectory of pedicle screw in frequency domain

“…Accuracy in placement of PS is very important for an e®ective PS¯xation. [1][2][3][4] Nowadays, the clinical standard for evaluation of PS position is by using ‡ Corresponding author. This is an Open Access article published by World Scienti¯c Publishing Company.…”