The Use of an Injectable, Biodegradable Calcium Phosphate Bone Substitute for the Prophylactic Augmentation of Osteoporotic Vertebrae and the Management of Vertebral Compression Fractures

Bai, Bo; Jazrawi, Laith M.; Kummer, Frederick J.; Spivak, Jeffrey M.

doi:10.1097/00007632-199908010-00004

Cited by 204 publications

(123 citation statements)

References 21 publications

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“…For example, a drop in ABP or changes in blood gases in an old osteoporotic patient can be easily misconstrued as result of cardiopulmonary disease [4]. Several authors have blamed PMMA toxicity for cardiopulmonary complications during cement augmentation procedures and suggest the use of less toxic, non-PMMA bone cement [12,13]. In our series, the occurrence of cement leakage and ABP drop were unrelated to the type of cement used.…”

Section: Discussionmentioning

confidence: 64%

Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty

et al. 2012

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Purpose The purpose of this study is to evaluate the effects of multilevel balloon kyphoplasty (BK) on blood pressure, blood gases and cement leakage. Methods This is a prospective study of 63 patients: 31 were treated for osteoporotic vertebral compressive fractures (OVCF) and 32 for osteolytic tumors (OT). Twentysix patients were treated at 1 level, 15 at 2, 2 at 3, 6 at 4, 3 at 5, 4 at 6, 5 at 7 and 2 at 8. PPMA was used in 43 patients and calcium phosphate in 20. All patients were treated under general anesthesia with continuous invasive monitoring of hemodynamic changes, arterial blood gases and peripheral and regional cerebral oxygen saturation.Results Two patients had a transient drop in blood pressure between 21 and 42 % during simultaneous inflation of all four balloons at two levels and three more patients during cement injection (two PMMA, one calcium phosphate). Five patients had a cement leak (7.9 %), which was unrelated to the cement type or number of levels. Blood pressure, end-tidal carbon dioxide partial pressure and arterial oxygen partial pressure decreased statistically, but without any clinical significance after cement insertion. Peripheral and regional cerebral oxygen saturation remained unchanged. One-way ANOVA revealed no difference between these changes when clustered by the groups single level, two levels and three or more levels. Conclusion BK performed under general anesthesia appears to be safe when applied in multiple levels in the same seating provided the balloons are inflated sequentially and not simultaneously and the cement is inserted slowly in a very doughy state. Close monitoring of cardiorespiratory factors is valuable. Its rare circulatory effects are unrelated to the number of levels or the cement type.

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Section: Discussionmentioning

confidence: 64%

Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty

et al. 2012

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“…Spine injuries is a serious medical condition that has a major impact on the quality of life of the patient [1,2]. Although there is a varying consensus among treating physicians, surgical fixation of a traumatic fracture of the thoracic or lumbar spine is considered necessary if axial and rotational stability is severely impaired or if a neurologic deficit is present or imminent.…”

Section: Introductionmentioning

confidence: 99%

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

Afzal¹,

Saleem²,

Dhar³

2008

Eur Spine J

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To assess the efficacy and feasibility of vertebroplasty and posterior short-segment pedicle screw fixation for the treatment of traumatic lumbar burst fractures. Short-segment pedicle screw instrumentation is a well described technique to reduce and stabilize thoracic and lumbar spine fractures. It is relatively a easy procedure but can only indirectly reduce a fractured vertebral body, and the means of augmenting the anterior column are limited. Hardware failure and a loss of reduction are recognized complications caused by insufficient anterior column support. Patients with traumatic lumbar burst fractures without neurologic deficits were included. After a short segment posterior reduction and fixation, bilateral transpedicular reduction of the endplate was performed using a balloon, and polymethyl methacrylate cement was injected. Pre-operative and post-operative central and anterior heights were assessed with radiographs and MRI. Sixteen patients underwent this procedure, and a substantial reduction of the endplates could be achieved with the technique. All patients recovered uneventfully, and the neurologic examination revealed no deficits. The postoperative radiographs and magnetic resonance images demonstrated a good fracture reduction and filling of the bone defect without unwarranted bone displacement. The central and anterior height of the vertebral body could be restored to 72 and 82% of the estimated intact height, respectively. Complications were cement leakage in three cases without clinical implications and one superficial wound infection. Posterior short-segment pedicle fixation in conjunction with balloon vertebroplasty seems to be a feasible option in the management of lumbar burst fractures, thereby addressing all the three columns through a single approach. Although cement leakage occurred but had no clinical consequences or neurological deficit.

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“…[37][38][39][40] Augmenting the void with a bone filler such as an autograft, allograft, or calcium phosphate cement may be considered to prevent subsequent compression fractures. The effect of this filler could also be tested using the techniques described in the current study and well as ultimate strength testing.…”

Section: Minimummentioning

confidence: 99%

The influence of pedicle screw placement on thoracic trabecular strain

et al. 2005

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The Use of an Injectable, Biodegradable Calcium Phosphate Bone Substitute for the Prophylactic Augmentation of Osteoporotic Vertebrae and the Management of Vertebral Compression Fractures

Abstract: This study demonstrated that the injection of a biodegradable calcium phosphate bone substitute to strengthen osteoporotic vertebral bodies or improve vertebral compression fractures might provide an alternative to the use of polymethylmethacrylate bone cement.

Cited by 204 publications

References 21 publications

Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty

Respiratory effects, hemodynamic changes and cement leakage during multilevel cement balloon kyphoplasty

Short segment pedicle screw instrumentation and augmentation vertebroplasty in lumbar burst fractures: an experience

The influence of pedicle screw placement on thoracic trabecular strain

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