Mechanical efficacy of vertebroplasty: Influence of cement type, BMD, fracture severity, and disc degeneration

Luo, Jin; Skrzypiec, D; Pollintine, P; Adams, Michael A.; Annesley-Williams, Deborah J.; Dolan, Patricia

doi:10.1016/j.bone.2006.11.021

Cited by 78 publications

(83 citation statements)

References 53 publications

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“…Furthermore, the results from these analyses are limited to uniform compressive loading. Using combined loading, disc degeneration has been shown to alter IVD stress peaks with disc degeneration in a flexed posture [24]. The numerical bone microdamage scheme in conjunction with a microstructural FE approach as presented in this study however, has been shown to reproduce the experimental Severely Damaged (III) Fig.…”

Section: Discussionmentioning

confidence: 84%

Early stage disc degeneration does not have an appreciable affect on stiffness and load transfer following vertebroplasty and kyphoplasty

2008

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Vertebroplasty and kyphoplasty have been reported to alter the mechanical behavior of the treated and adjacent-level segments, and have been suggested to increase the risk for adjacent-level fractures. The intervertebral disc (IVD) plays an important role in the mechanical behavior of vertebral motion segments. Comparisons between normal and degenerative IVD motion segments following cement augmentation have yet to be reported. A microstructural finite element model of a degenerative IVD motion segment was constructed from micro-CT images. Microdamage within the vertebral body trabecular structure was used to simulate a slightly (I = 83.5% of intact stiffness), moderately (II = 57.8% of intact stiffness), and severely (III = 16.0% of intact stiffness) damaged motion segment. Six variable geometry single-segment cement repair strategies (models A-F) were studied at each damage level (I-III). IVD and bone stresses, and motion segment stiffness, were compared with the intact and baseline damage models (untreated), as well as, previous findings using normal IVD models with the same repair strategies. Overall, small differences were observed in motion segment stiffness and average stresses between the degenerative and normal disc repair models. We did however observe a reduction in endplate bulge and a redistribution in the microstructural tissue level stresses across both endplates and in the treated segment following early stage IVD degeneration. The cement augmentation strategy placing bone cement along the periphery of the vertebra (model E) proved to be the most advantageous in treating the degenerative IVD models by showing larger reductions in the average bone stresses (vertebral and endplate) as compared to the normal IVD models. Furthermore, only this repair strategy, and the complete cement fill strategy (model F), were able to restore the slightly damaged (I) motion segment stiffness above pre-damaged (intact) levels. Early stage IVD degeneration does not have an appreciable effect in motion segment stiffness and average stresses in the treated and adjacent-level segments following vertebroplasty and kyphoplasty. Placing bone cement in the periphery of the damaged vertebra in a degenerative IVD motion segment, minimizes load transfer, and may reduce the likelihood of adjacent-level fractures.

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Section: Discussionmentioning

confidence: 84%

Early stage disc degeneration does not have an appreciable affect on stiffness and load transfer following vertebroplasty and kyphoplasty

2008

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“…However, others have reported that the restoration of mechanical function following vertebroplasty is little influenced by cement type 14) . Even intradiscal cement leakage has been reported to be 1) or not to be 2) related to subsequent fracture.…”

Section: Discussionmentioning

confidence: 99%

“…In general, a low body mass index and a low body weight are risk factors of recurrent fractures of the spine, and a low BMD is associated with increased fracture severity (height loss) and greater changes in stiffness and load-shearing following fracture. Low BMD and severe fractures are also associated with greater mechanical changes following vertebroplasty, 14) and significant anterior vertebral height restoration increases the risk of subsequent fracture in cemented vertebrae 11,14) . The relationship between initial vertebral height restoration and pain relief is controversial.…”

Section: Discussionmentioning

confidence: 99%

The Proper Volume and Distribution of Cement Augmentation on Percutaneous Vertebroplasty

Kim

Park

et al. 2010

J Korean Neurosurg Soc

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Objective : The purpose of this study was to determine the optimal volume of injected cement and its distribution when used to treat vertebral compression fractures, and to identify factors related to subsequent vertebral fractures. Methods : A retrospective analysis of newly developing vertebral fractures after percutaneous vertebroplasty was done. The inclusion criteria were that the fracture was a single first onset fracture with exclusion of pathologic fractures. Forty-three patients were included in the study with a minimum follow up period of six months. Patients were dichotomized for the analysis by volume of cement, initial vertebral height loss, bone marrow density, and endplate-to-endplate cement augmentation. Results : None of the four study variables was found to be significantly associated with the occurrence of a subsequent vertebral compression fracture. In particular, and injected cement volume of more or less that 3.5 cc was not associated with occurrence (p = 0.2523). No relation was observed between initial vertebral height loss and bone marrow density (p = 0.1652, 0.2064). Furthermore, endplate-to-endplate cement augmentation was also not found to be significantly associated with a subsequent fracture (p = 0.2860) by Fisher's exact test. Conclusion : Neither volume of cement, initial vertebral height loss, bone marrow density, or endplate-to-endplate cement augmentation was found to be significantly related to the occurrence of a subsequent vertebral compression fracture. Our findings suggest that as much cement as possible without causing leakage should be used.

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“…3 Luo Skrzypiec et al [20] wiesen nach, dass insbesondere bei niedriger Knochendichte aufgrund der besonders hohen Steifigkeitsunterschiede eher Anschlussfrakturen auftreten, wohingegen das Risiko bei Patienten mit normaler Knochendichte deutlich niedriger ist.…”

Section: Diskussionunclassified

Zementaugmentation an der Wirbelsäule

et al. 2015

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Mechanical efficacy of vertebroplasty: Influence of cement type, BMD, fracture severity, and disc degeneration

Cited by 78 publications

References 53 publications

Early stage disc degeneration does not have an appreciable affect on stiffness and load transfer following vertebroplasty and kyphoplasty

Early stage disc degeneration does not have an appreciable affect on stiffness and load transfer following vertebroplasty and kyphoplasty

The Proper Volume and Distribution of Cement Augmentation on Percutaneous Vertebroplasty

Zementaugmentation an der Wirbelsäule

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