Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis

Dai, Haowen; Liu, Yang; Han, Qing; Zhang, Aobo; Chen, Hao; Qu, Yang; Wang, Jincheng; Zhao, Jianwu

doi:10.3389/fbioe.2022.978917

Cited by 19 publications

(20 citation statements)

References 69 publications

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“…Low spinal stability may lead to an increased risk of recompression. In this study, filling with bone cement reduced the maximum displacement of the KD specimens and approached the intact vertebrae, which was also demonstrated by some related studies ( Dai et al, 2022 ). However, in the PKP group, the specimens still differed from the intact vertebrae in terms of stability during rotation.…”

Section: Discussionsupporting

confidence: 87%

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel’s disease in porcine vertebrae

Feng

Zhang

et al. 2023

Front. Bioeng. Biotechnol.

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Background and objective: Treatment of Kümmel’s Disease (KD) with pure percutaneous kyphoplasty carries a greater likelihood of bone cement displacement due to hardened bone and defect of the peripheral cortex. In this study, we designed a novel minimally invasive pedicle bone cement screw and evaluate the effectiveness and safety of this modified surgical instruments in porcine vertebrae.Methods: 18 mature porcine spine specimens were obtained and soaked in 10% formaldehyde solution for 24 h. 0.5000 mmol/L EDTA-Na2 solution was used to develop in vitro osteoporosis models of porcine vertebrae. They were all made with the bone deficiency at the anterior edge of L1. These specimens were randomly divided into 3 groups for different ways of treatment: Group A: pure percutaneous kyphoplasty (PKP) group; Group B: unilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group; Group C: bilateral novel minimally invasive pedicle bone cement screw fixation combined with PKP group. The MTS multi-degree of freedom simulation test system was used for biomechanical tests, including axial loading of 500 N pressure, range of motion (ROM) in flexion, extension, left/right lateral bending, and left/right axial rotation at 5 Nm, and the displacement of bone cement mass at maximum angles of 5° and 10°.Result: The three groups were well filled with bone cement, no leakage or displacement of bone cement was observed, and the height of the vertebrae was higher than pre-operation (p < 0.05). In the left/right axial rotation, the specimens were still significantly different (p < 0.05) from the intact specimens in terms of ROM after PKP. In other directions, ROM of all group had no significant difference (p < 0.05) and was close to the intact vertebrae. Compared with PKP group, the relative displacement of bone cement in groups B and C was smaller (p < 0.05).Conclusion: In the in vitro animal vertebral models, the treatment of KD with the placement of novel pedicle minimally invasive bone cement screw combined with PKP can effectively restore the vertebral height, improve the stability of the affected vertebra and prevent the displacement of bone cement. Biomechanically, there is no significant difference between bilateral and unilateral fixation.

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Section: Discussionsupporting

confidence: 87%

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel’s disease in porcine vertebrae

Feng

Zhang

et al. 2023

Front. Bioeng. Biotechnol.

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“…Some studies have shown that cement distribution and vertebral stiffness are important factors affecting the stress balance of the vertebral body for recompression fractures of the vertebral body after PVP [33]. This asymmetric cement distribution may reduce the stiffness of the non-reinforcing side, leading to fracture recurrence [34]. Therefore, PKP combined with hollow pedicle screws is superior to PKP combined with pediculoplasty and superior to PKP alone in reducing the risk of adjacent vertebral fracture, adjacent disc degeneration, and vertebral refracture, and bilateral surgery is superior to unilateral surgery.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical effects of a novel hollow pedicle screw in the minimally invasive treatment of Kümmell disease: a finite element study

Zhong,

Huang

et al. 2024

Preprint

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Background Vertebral augmentation is the preferred treatment for Kümmell disease (KD), but there exists a risk of cement displacement resulting in severe back pain and exacerbation of kyphosis. The study aimed to investigate and evaluate the biomechanical behavior of a novel hollow pedicle screw in the minimally invasive treatment of Kümmell disease by finite element (FE) analysis. Methods A finite element model of the thoracolumbar T12-L2 vertebral bodies of a KD patient treated with PKP was established. Part of the bone tissue of the T12 vertebral body was removed to simulate the intravertebral vacuum cleft in the injured vertebra. Based on these, the FE model of KD was established. The finite element model was used to simulate the treatment of KD with three surgical methods. Including six models: Model 1 is the osteoporotic vertebral compression fracture vertebra with IVC; Model 2 is simply unilateral PKP; Model 3 is unilateral PKP combined with pediculoplasty; Model 4 is bilateral PKP combined with pediculoplasty; Model 5 is unilateral PKP combined with a hollow pedicle screw (PKP-HPS); Model 6 is bilateral PKP-HPS. In addition, under certain loading conditions, the maximum von Mises stress, and stress distribution of bone cement, vertebral bodies, intervertebral discs of the six models, and the bone cement displacement of the postoperative models were analyzed and compared. Results Finite element analysis showed that the maximum von Mises stress of the T12 vertebra was reduced by almost 50% after the operation. Under the same conditions, the stresses of the bilateral operation models were less than those of the unilateral operation models, and the stress distribution of the bilateral operation models was more symmetrical than that of the unilateral operation model in discs, vertebral bodies, and bone cement. In addition, PKP-HPS models are superior to PKP combined with pediculoplasty models in reducing the stress on adjacent vertebral bodies and intervertebral discs after operation compared with the preoperative model and PKP alone. Besides, the M2 and M3 models showed significantly greater displacement than the other models, and M6 showed the smallest displacement. Conclusion Bilateral PKP-HPS has better stability in the treatment of KD, and can effectively avoid the loosening or displacement of bone cement. It can take advantage of simple PKP and PKP combined with pediculoplasty at the same time and can reduce the risk of vertebral re-fracture or collapse, adjacent vertebral fracture, and bone cement instability.

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“…The biomechanical imbalance can exacerbate the pressure load on the spine, leading to irreversible effects such as loss of height of the fractured vertebral body, disc degeneration in adjacent segments, and even vertebral fractures in adjacent segments [ 20 ]. A biomechanical study by Dai et al demonstrated that BPKP balanced vertebral stresses, reduced maximum disc stresses, and was more stable than UPKP [ 21 ]. Hou et al conducted a retrospective study and found that symmetrical distribution of bone cement in the vertebral body significantly reduced the incidence of vertebral recompression [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Bipedicular percutaneous kyphoplasty versus unipedicular percutaneous kyphoplasty in the treatment of asymmetric osteoporotic vertebral compression fractures: a case control study

Liu,

Song,

Shang

et al. 2023

BMC Surg

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Background Bipedicular/unipedicular percutaneous kyphoplasty are common treatments for OVCF, and there are no studies to show which is more beneficial for AVCF. The purpose of this study was to investigate the clinical efficacy of BPKP or UPKP in the treatment of AVCF. Methods The clinical data of AVCF patients treated by PKP were retrospectively analyzed. They were divided into two groups according to the surgical approach. General demographic data, perioperative complications, and general information related to surgery were recorded for both groups. The preoperative and postoperative vertebral height difference, vertebral local Cobb angle, lumbar pain VAS score and lumbar JOA score were counted for both groups. The above data were compared preoperatively, postoperatively and between the two groups. Results 25 patients with AVCF were successfully included and all were followed up for at least 12 months, with no complications during the follow-up period. 10 patients in the BPKP group and 15 patients in the UPKP group, with no statistically significant differences in general information between the two groups. The VAS scores of patients in the BPKP group were lower than those in the UPKP group at 12 months after surgery, and the differences were statistically significant, and there were no statistically significant differences between the two groups at other follow-up time points. In the BPKP group, 80% of patients had symmetrical and more homogeneous bone cement dispersion. 50% of patients in the UPKP group had a lateral distribution of bone cement and uneven bone cement distribution, and the difference in bone cement distribution between the two groups was statistically significant. Conclusion For the treatment of AVCF, the clinical efficacy of both surgical approaches is basically the same. The distribution of cement is more symmetrical and uniformly diffused in the BPKP group, and the clinical efficacy VAS score is lower in the long-term follow-up. Bipedicular percutaneous kyphoplasty is recommended for the treatment of AVCF. The ethical review batch number XZXY-LJ-20161208-047.

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Biomechanical comparison between unilateral and bilateral percutaneous vertebroplasty for osteoporotic vertebral compression fractures: A finite element analysis

Cited by 19 publications

References 69 publications

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel’s disease in porcine vertebrae

Biomechanical evaluation of a novel minimally invasive pedicle bone cement screw applied to the treatment of Kümmel’s disease in porcine vertebrae

Biomechanical effects of a novel hollow pedicle screw in the minimally invasive treatment of Kümmell disease: a finite element study

Bipedicular percutaneous kyphoplasty versus unipedicular percutaneous kyphoplasty in the treatment of asymmetric osteoporotic vertebral compression fractures: a case control study

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