Adjacent Vertebral Body Fracture Following Vertebroplasty With Polymethylmethacrylate or Calcium Phosphate Cement

Nouda, Shinya; Tomita, Seiji; Kin, Akihiro; Kawahara, Kunihiko; Koshi, Mitsuo

doi:10.1097/brs.0b013e3181abc150

Cited by 56 publications

(39 citation statements)

References 17 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.…”

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 types of cement in addition to PMMA have also been developed for augmentation. In comparison with PMMA, calcium phosphate cement, for example, leads to fewer adjacent fractures in biomechanical studies, although, the rate of recurrent fractures in the augmented vertebrae themselves is still very high [58]. The use of completely different augmentation materials, such as silicone, instead of cement to achieve better stiffness parameters is new, however.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades

et al. 2013

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Purpose Vertebral augmentation with PMMA is a widely applied treatment of vertebral osteoporotic compression fractures. Subsequent fractures are a common complication, possibly due to the relatively high stiffness of PMMA in comparison with bone. Silicone as an augmentation material has biomechanical properties closer to those of bone and might, therefore, be an alternative. The study aimed to investigate the biomechanical differences, especially stiffness, of vertebral bodies with two augmentation materials and two filling grades. Methods Forty intact human osteoporotic vertebrae (T10-L5) were studied. Wedge fractures were produced in a standardized manner. For treatment, PMMA and silicone at two filling grades (16 and 35 % vertebral body fill) were assigned to four groups. Each specimen received 5,000 load cycles with a high load range of 20-65 % of fracture force, and stiffness was measured. Additional low-load stiffness measurements (100-500 N) were performed for intact and augmented vertebrae and after cyclic loading. Results Low-load stiffness testing after cyclic loading normalized to intact vertebrae showed increased stiffness with 35 and 16 % PMMA (115 and 110 %) and reduced stiffness with 35 and 16 % silicone (87 and 82 %). After cyclic loading (high load range), the stiffness normalized to the untreated vertebrae was 361 and 304 % with 35 and 16 % PMMA, and 243 and 222 % with 35 and 16 % silicone augmentation. For both high and low load ranges, the augmentation material had a significant effect on the stiffness of the augmented vertebra, while the filling grade did not significantly affect stiffness. Conclusions This study for the first time directly compared the stiffness of silicone-augmented and PMMAaugmented vertebral bodies. Silicone may be a viable option in the treatment of osteoporotic fractures and it has the biomechanical potential to reduce the risk of secondary fractures.

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“…Vertebroplasty, however, has gained increasing popularity over the last two decades acting in both preventative and therapeutic capacities. Vertebral augmentation with bone cement-most commonly polymethylmethacrylate (PMMA)-has provided early clinical improvement in regard to pain relief in more than 90% of cases [13] (Figure 5). Biomechanically, it serves to retain the normal vertebral and spinal geometry by increasing the VB stiffness and strength.…”

Section: Vertebroplastymentioning

confidence: 99%

“…But the procedure is not without risk. PMMA goes through an exothermic reaction which can cause neurological damage, localized inflammation and osteonecrosis [13] . There are also concerns regarding cement leakage, which can encroach into the spinal canal with disastrous consequences [3] .…”

Section: Vertebroplastymentioning

confidence: 99%

Methods of predicting vertebral body fractures of the lumbar spine

Sisodia

2013

WJO

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Lumbar vertebral body (VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density (BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models for VB fracture risk should encompass a range of important parameters including BMD, geometric measures and patient-specific factors. As interventions like vertebroplasty increase in popularity for VB fracture treatment and prevention, such models are likely to play a significant role in the clinical decision-making process. More biomechanical research is required, however, to reduce the risks of post-operative adjacent VB fractures. Core tip: Lumbar vertebral body (VB) fractures are increasingly common in an ageing population that is at greater risk of osteoporosis and metastasis. This review aims to identify different models, as alternatives to bone mineral density (BMD), which may be applied in order to predict VB failure load and fracture risk. The most representative models are those that take account of normal spinal kinetics and assess the contribution of the cortical shell to vertebral strength. Overall, predictive models for VB fracture risk should encompass a range of important parameters including BMD, geometric measures and patient-specific factors.Sisodia GB. Methods of predicting vertebral body fractures of the lumbar spine. World J Orthop 2013; 4(4): 241-247 Available from:

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Adjacent Vertebral Body Fracture Following Vertebroplasty With Polymethylmethacrylate or Calcium Phosphate Cement

Cited by 56 publications

References 17 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

Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades

Methods of predicting vertebral body fractures of the lumbar spine

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