Biological Fixation of Bioactive Bone Cement in Vertebroplasty: The First Clinical Investigation of Borosilicate Glass (BSG) Reinforced PMMA Bone Cement

Abstract

PMMA bone cement has been clinically used for decades in vertebroplasty due to its high mechanical strength and satisfactory injectability. However, the interface between bone and PMMA is fragile and more prone to refracture in situ because PMMA lacks a proper biological response from the host bone with minimal bone integration and dense fibrous tissue formation. Here, we modified PMMA by incoporating borosilicate glass (BSG) with a dual glass network of [BO 3 ] and [SiO 4 ], which spontaneously modulates immunity and osteogenesis. In particular, the BSG modified PMMA bone cement (abbreviated as BSG/PMMA cement) provided an alkaline microenvironment that spontaneously balanced the activities between osteoclasts and osteoblasts. Furthermore, the trace elements released from the BSGs enhanced the osteogenesis to strengthen the interface between the host bone and the implant. This study shows the first clinical case after implantation of BSG/PMMA for three months using the dual-energy CT, which found apatite nucleation around PMMA instead of fibrous tissues, indicating the biological interface was formed. Therefore, BSG/PMMA is promising as a biomaterial in vertebroplasty, overcoming the drawback of PMMA by improving the biological response from the host bone.

Sol–gel derived B2O3–CaO borate bioactive glasses with hemostatic, antibacterial and pro-angiogenic activities

“…The use of boron-containing BGs has aroused some concerns in biomedical applications, due to a generalized view of boron compounds as toxic chemical entities [ 58 ]. However, there are also numerous studies reporting the low toxicity risk of using boron-containing compounds, including boron-containing BGs [ 59 ]. It is important to understand local toxicity effects of boron-containing BGs and their potential influence on the main organs when these BGs are translated to clinical applications.…”

“…Recently, a study performed by Zhang et al . [ 59 ] reported that the implantation of borosilicate BG reinforced PMMA bone cement did not elicit acute systemic toxicity or skin irritation and it did not cause visible damage or weight change to the heart, liver, lung and kidney of rats. The biosafety of the composite bone cement was also verified in large animal models, including rabbits and goats and the results of a first human clinical trial were also favorable.…”

Preclinical Evaluation of Bioactive Small Intestinal Submucosa-PMMA Bone Cement for Vertebral Augmentation

“…The literature indicated that these problems or risks are because of PMMA's increased elastic modulus, high setting temperature, and lack of bone-bonding ability. 5−8 Currently, the incorporation of inorganic fillers, including hydroxyapatite (HA), 9 β-tricalcium phosphate (β-TCP), 10,11 and bioglass, 12 has proved to be an effective method to reduce the PMMA-associated risks. However, the application of these hybrid bone cements in spinal repair requires more research because of their poor anticollapse properties and injection performance.…”

Dual-Setting Bone Cement Based On Magnesium Phosphate Modified with Glycol Methacrylate Designed for Biomedical Applications

“…Moreover, apatite cements were used as dual-setting systems in combination with methacrylated dextran, ammonium polyacrylate, and isocyanate-modified prepolymer . There is also research on the development of new composite bone cements based on PMMA matrix modified with, i.e., CaP, carbon nanotubes, amine-functionalized graphene, or borosilicate glass . Further, Rad et al developed bioactive cement based on three components: PMMA, elastin, and nanohydroxyapatite .…”