In silico evaluation of stress distribution after vertebral body augmentation with conventional acrylics, composites and glass polyalkenoate cements

Dickey, Brett; Tyndyk, Magdalena; Doman, Darrel A.; Boyd, Daniel

doi:10.1016/j.jmbbm.2011.08.007

Cited by 6 publications

(9 citation statements)

References 30 publications

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“…The FE model incorporates a simplified but patient-specific mechanical model of the vertebra, with only compressive loading and prophylactic vertebroplasty simulated. This has the advantage that multiple treatment scenarios can be rapidly computed and compared, which is considered valid and well-accepted for the accurate prediction of compressive strength and fracture risk [ 39 , 63 ]. It is recommended, however, that a conclusive assessment of treatment effectiveness be verified through the simulation of functional spinal units (FSUs) including fractured vertebrae in order to assess fracture risk at adjacent or remote levels, incorporating spectra of multi-axial loading and age-related daily activities.…”

Section: Discussionmentioning

confidence: 99%

“…Inconsistently, clinical studies [ 17 , 20 ] reported that the incidence of new fractures was not different after PVP, compared with conservative treatment after one year of follow-up. The major limitations of the biomechanical studies that could explain these divergent conclusions were the limited number of specimens and/or experimental trials (a problem generally associated with cadaveric testing) [ 25 , 26 , 28 – 32 , 34 – 36 ] and Finite Element (FE) models that were limited to the study of a single case [ 26 , 29 , 30 ], constructed on the basis of non-realistic, predefined cement distributions [ 24 , 31 , 37 – 39 ], cement distributions reconstructed from patient radiographs [ 40 ] or peripheral quantitative computed tomography (pQCT) scans of human cadaveric specimens [ 41 ] with potentially suboptimal cement placement and/or filling strategy. Furthermore, the complex composite properties of cement-augmented bone have been neglected.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, the complex composite properties of cement-augmented bone have been neglected. A fundamental limitation of such biomechanical studies is the evaluation of physical units (endplate deflection [ 24 , 30 ], failure load [ 28 ], maximum principal strain [ 30 ], pressure [ 26 , 29 , 30 ], stresses [ 29 , 37 , 39 , 41 ], stiffness [ 30 , 31 ] or strength [ 34 , 37 , 38 ] that form the basis for the inference as to whether PVP induces adjacent fractures or is efficient from the biomechanical perspective. It has been shown that absolute values alone, e.g.…”

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy

et al. 2016

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PurposeVertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment.MethodsA Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments.ResultsThe results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture.ConclusionsWe conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy

et al. 2016

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“…PMMA however comes along with specific disadvantageous characteristics. PMMA generates significant heat during the exothermic hardening process and it lacks biologic integration and healing due to induction of chemical or thermal necrosis within the vertebral body [9]. Moreover, the elastic modulus of PMMA exceeds the one of cancellous bone up to the 30-fold [1, 9–11].…”

Section: Introductionmentioning

confidence: 99%

“…PMMA generates significant heat during the exothermic hardening process and it lacks biologic integration and healing due to induction of chemical or thermal necrosis within the vertebral body [9]. Moreover, the elastic modulus of PMMA exceeds the one of cancellous bone up to the 30-fold [1, 9–11]. This mismatch of mechanical properties might contribute to significantly higher onset of vertebral fractures adjacent to augmented levels [4, 12].…”

Section: Introductionmentioning

confidence: 99%

Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement

Meyer

Gaalen

Leschinger

et al. 2019

BioMed Research International

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If conservative treatment of osteoporotic vertebral compression fractures fails, vertebro- or kyphoplasty is indicated. Usually, polymethylmethacrylate cement (PMMA) is applied coming along with many disadvantageous features. Aluminum-free glass-polyalkenoate cement (GPC) appears to be a benefit alternative material. This study aimed at comparing the mean stress values in human vertebrae after kyphoplasty with PMMA and GPC (IlluminOss™) at hand of a finite element analysis. Three models were created performing kyphoplasty using PMMA or IlluminOss™, respectively, at two native, human lumbar vertebrae (L4) while one remains intact. Finite element analysis was performed using CT-scans of every vertebra. Moreover the PMMA-treated vertebra was used as a model as analyses were executed using material data of PMMA and of GPC. The unimpaired, spongious bone showed potentials of 0.25 MPa maximally. After augmentation stress levels showed fivefold increase, rising from externally to internally, revealing stress peaks at the ventral border of the spinal canal. At central areas of cement 1 MPa is measured in both types of cement. Around these central areas the von Mises stress decreased about 25-50% (0.5-0.75 MPa). If workload of 500 N was applied, the stress appeared to be more centralized at the IlluminOss™-model, similar to the unimpaired. Considering the endplates the GPC model also closely resembles the unimpaired. Comparing the PMMA-treated vertebral body and the GPC-simulation, there is an obvious difference. While the PMMA-treated model showed a central stress peak of 5 MPa, the GPC-simulation of the same vertebral body presents lower stress of 1.2-2.5 MPa. Finite element analysis showed that IlluminOss™ (GPC), used in kyphoplasty of vertebral bodies, creates lower level stress and strain compared to standardly used PMMA, leading to lower stress concentrations on the cranial and caudal vertebral surface especially. GPC appears to own advantageous biological and clinical relevant features.

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Bioactive glasses 2: Composite bone void fillers

Mokhtari

Wren

2018

Bioactive Glasses

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In silico evaluation of stress distribution after vertebral body augmentation with conventional acrylics, composites and glass polyalkenoate cements

Cited by 6 publications

References 30 publications

The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy

The Effectiveness of Percutaneous Vertebroplasty Is Determined by the Patient-Specific Bone Condition and the Treatment Strategy

Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement

Bioactive glasses 2: Composite bone void fillers

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