Temperature elevation caused by bone cement polymerization during vertebroplasty

Deramond, H.; Wright, Neil T.; Belkoff, Stephen M.

doi:10.1016/s8756-3282(99)00127-1

Cited by 333 publications

(174 citation statements)

References 19 publications

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“…This temperature rise is comparable to the temperature rise found in cadaveric studies looking at heat generation in bone cement polymerization in vertebral bodies [26]. The peak absolute temperatures from LITT were similar or less than the reported values of 39°C to 110°C for polymerization temperatures at the bone-cement interface [2,3,4,11,26]. In vivo, such temperature rises along the posterior vertebral body wall will likely be reduced due to the circulatory effects of the blood and cerebrospinal fluid.…”

Section: Discussionsupporting

confidence: 79%

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

et al. 2007

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A biomechanical study comparing simulated lytic vertebral metastases treated with laser-induced thermotherapy (LITT) and vertebroplasty versus vertebroplasty alone. To investigate the effect of tumor ablation using LITT prior to vertebroplasty on biomechanical stability and cement fill patterns in a standardized model of spinal metastatic disease. Vertebroplasty in the metastatic spine is aimed at reducing pain, but is associated with risk of cement extravasation in up to 10%. Six pairs of fresh-frozen cadaveric thoracolumbar spinal motion segments were tested in axial compression intact, with simulated metastases and following percutaneous vertebroplasty with or without LITT. Canal narrowing under load, pattern of cement fill, load to failure, and LITT temperature and pressure generation were collected. In all LITT specimens, cement filled the defect without extravasation. The canal extravasation rate was 33% in specimens treated without LITT. LITT and vertebroplasty yielded a trend toward improved posterior wall stability (P = 0.095) as compared to vertebroplasty alone. Moderate rises in temperature and minimal pressure generation was seen during LITT. In this model, elimination of tumor by LITT, facilitates cement fill, enhances biomechanical stability and reduces the risk of cement extravasation.

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Section: Discussionsupporting

confidence: 79%

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

et al. 2007

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“…3,5,8 In the event of CPC leakage, the damage to surrounding tissue most likely will be less compared with PMMA, by virtue of its isothermic properties during the setting phase. 7,15 Although the use of PMMA cement in vertebroplasty is widespread, no data on the long-term behavior of the material for spinal applications have been published. Because the majority of patients with traumatic vertebral fractures are aged between 20 and 50 years, the use of a more biocompatible bone cement is preferred.…”

Section: Discussionmentioning

confidence: 99%

Balloon Vertebroplasty with Calcium Phosphate Cement Augmentation for Direct Restoration of Traumatic Thoracolumbar Vertebral Fractures

Verlaan

Helden

Oner

et al. 2002

Spine

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Study Design. A human cadaveric model was used to evaluate balloon vertebroplasty in traumatic vertebral fractures.Objectives. To assess the feasibility and safety of balloon vertebroplasty followed by calcium phosphate cement augmentation to prevent recurrent kyphosis.Summary of Background Data. Failure after short-segment pedicle-screw fixation for the treatment of vertebral fractures is probably caused by a redistribution of disc material through the fractured endplate into the vertebral body, causing a decrease in anterior column support. This lack of support can give rise to instrument breakage and recurrent kyphosis after removal of the instrumentation. Restoration of the endplate morphology could prevent these events.Methods. Twenty-three traumatic fractures of thoracolumbar vertebrae were created. All fractures were distracted and fixated with short-segment pedicle screws and rods. Transpedicularly introduced inflatable bone tamps and subsequent injection of calcium phosphate cement were used to restore the endplates. Quantitative analyses of magnetic resonance images obtained at three time points were used to evaluate the morphology of the vertebral body and disc-space. After slicing all specimens, macroscopical examination was performed to detect leakage of cement or bone displacement in undesired directions.Results. No technical problems were encountered during the study. The balloon vertebroplasty resulted in a significant (P ϭ 0.0014) decrease of cranial endplate impression. No cement leakage or undesired bone displacement could be detected radiologically or macroscopically.Conclusions. The present study suggests that balloon vertebroplasty may be a safe and feasible procedure for the restoration of traumatic thoracolumbar vertebral fractures.

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“…The mechanism by which PVP achieves its palliative effect is not known. It may be due to the initial stability that it provides or due to neuronal damage caused by heat liberated during polymerization [17].…”

Section: Introductionmentioning

confidence: 99%

Vertebroplasty for osteoporotic spine fracture: prevention and treatment

2005

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IntroductionOsteoporosis is a disorder of decreased bone mass, microstructural collapse, and fragility fractures. It can affect people of all ethnic backgrounds and can result in challenging complications, ranging from compression fractures of vertebral bodies to femoral neck fractures [59]. The geriatric population is especially at risk for such osteoporotic fractures, as bone mass decreases with age [53]. A loss of one standard deviation of bone mass doubles the risk of spine fractures [34,56,59]. It is estimated that 90% of hip and spine fractures occurring in the elderly are attributable to osteoporosis [45]. The consequences of such osteoporotic vertebral fractures are diverse and include back pain, functional limitations and impairment of mood [11,37,58].A recent study in Canada examined the health-related quality of life (HRQL) in women aged 50 years and older with osteoporosis [1]. Subjects who had experienced a vertebral fracture had lower HRQL scores than participants without fracture in total score, symptoms, physical function, activities of daily living, and leisure. Acute complications of osteoporotic vertebral fractures include transient ileus, urinary retention, nausea, abdominal pain and chest pain [41,49]. Long-term effects of osteoporotic fracAbstract There is a relatively high prevalence of osteoporotic vertebral compression fractures (VCFs) in the elderly population, especially in women aged 50 or older. The result of these VCFs is increased morbidity and mortality in the short and long term. Medical treatment of these fractures includes bed rest, orthotics, analgesic medication and time. Percutaneous vertebroplasty (PVP) consists of percutaneous injection of biomaterial, such as methylmethacrylate, into the VCF to produce stability and pain relief. Biomechanical testing has shown that PVP can restore strength and stiffness of the vertebral body to the pre-fracture levels. Clinical results show immediate and maintained pain relief in 70-95% of the patients. Possible major complications include cement leakage into the spinal canal or into the venous system. Additionally, percutaneous vertebroplasty may alter the normal loading behavior of the adjacent vertebral body, and there is an increased risk of adjacent segment VCF. Kyphoplasty is a new technique, which introduces a balloon into the vertebral body transpedicularly to reduce the VCF while creating a cavity for the cement injection. This technique has the benefit of kyphosis reduction as well as less cement leakage. Research continues into the development of injectable biomaterials that are resorbable and allow for new bone formation. Vertebroplasty and kyphoplasty are safe and effective in the treatment of osteoporotic VCFs. They may allow for a faster return to function, and thus avoid the morbidity associated with medical treatment.

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Temperature elevation caused by bone cement polymerization during vertebroplasty

Cited by 333 publications

References 19 publications

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

The effect of pre-vertebroplasty tumor ablation using laser-induced thermotherapy on biomechanical stability and cement fill in the metastatic spine

Balloon Vertebroplasty with Calcium Phosphate Cement Augmentation for Direct Restoration of Traumatic Thoracolumbar Vertebral Fractures

Vertebroplasty for osteoporotic spine fracture: prevention and treatment

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