Percutaneous Vertebroplasty Is Not a Risk Factor for New Osteoporotic Compression Fractures: Results from VERTOS II

Klazen, Caroline A. H.; Venmans, A.; Vries, Jolanda De; Rooij, W.J. van; Jansen, Frits H.; Blonk, M. C.; Lohle, P. N. M.; Juttmann, J. R.; Buskens, Erik; Everdingen, K.J. van; Muller, A F; Fransen, H.; Elgersma, Otto E. H.; Mali, W P; Verhaar, H.J.J.

doi:10.3174/ajnr.a2148

Cited by 121 publications

(77 citation statements)

References 22 publications

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“…Of concern is the increased risk of adjacent vertebral body fractures observed in clinical [4,5] and experimental studies [6][7][8]. Although a recent randomized controlled trial comparing vertebroplasty to conservative treatment [9] found no significant difference in adjacent-level fracture incidence, clinically used poly-methyl-methacrylate (PMMA) cements caused marked changes in load transfer. A pressure increase in the nucleus pulposus and a reduced inward deflection of the augmented endplate were observed following augmentation [10,11].…”

Section: Introductionmentioning

confidence: 99%

The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

et al. 2011

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Purpose Vertebroplasty restores stiffness and strength of fractured vertebral bodies, but alters their stress transfer. This unwanted effect may be reduced by using more compliant cements. However, systematic experimental comparison of structural properties between standard and low-modulus augmentation needs to be done. This study investigated how standard and low-modulus cement augmentation affects apparent stiffness, strength, and endplate pressure distribution of vertebral body sections. Methods Thirty-nine human thoracolumbar vertebral body sections were prepared by removing cortical endplates and posterior elements. The specimens were scanned with a HR-pQCT system and loaded in the elastic range. After augmentation with standard or low-modulus cement they were scanned again and tested in two steps. First, the contact pressure distribution between specimen and loading plates was measured with pressure-sensitive films. Then, they were loaded again in the elastic range and compressed until failure. Apparent stiffness was compared before and after augmentation, whereas apparent strength of augmented specimens was compared to a nonaugmented reference group. Results Vertebral body sections with fillings connecting both endplates were on average 33% stiffer and 47% stronger with standard cement, and 27% stiffer and 30% stronger with low-modulus cement. In contrast, partial fillings showed no significant strengthening for both cements and only a slight stiffness increase (\16%). The averaged endplate pressure above/below the cement was on average 15% lower with low-modulus cement compared to standard cement. Conclusion Augmentation connecting both endplates significantly strengthened and stiffened vertebral body sections also with low-modulus cement. A trend of reduced pressure concentrations above/below the cement was observed with low-modulus cement.

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Section: Introductionmentioning

confidence: 99%

The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

et al. 2011

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“…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] . However it is still debated, whether adjacent vertebral fractures can simply be attributed to the progression of the underlying disease or because of an altered load pattern in the spine after the augmentation 30 .…”

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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“…The hypothesis proposed to explain these adjacent new fractures lies in the change in force exerted on the adjacent level due to the cement burden. Nevertheless, the trigger role of PVP for osteoporotic new fractures is still a matter of debate; some authors [28] have shown no additional risk of fracture after PVP in osteoporosis, and posit that new VCFs may be due to the natural history of the osteoporotic disease.…”

Section: Discussionmentioning

confidence: 97%

Safety and Clinical Effectiveness of Percutaneous Vertebroplasty in the Elderly (≥80 years)

et al. 2015

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Percutaneous Vertebroplasty Is Not a Risk Factor for New Osteoporotic Compression Fractures: Results from VERTOS II

Cited by 121 publications

References 22 publications

The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

The effect of standard and low-modulus cement augmentation on the stiffness, strength, and endplate pressure distribution in vertebroplasty

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

Safety and Clinical Effectiveness of Percutaneous Vertebroplasty in the Elderly (≥80 years)

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