Theoretical and experimental model to describe the injection of a polymethylmethacrylate cement into a porous structure

Bohner, Marc; Gasser, B.; Baroud, Gamal; Heini, Paul F.

doi:10.1016/s0142-9612(03)00086-3

Cited by 180 publications

(143 citation statements)

References 13 publications

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“…This was confirmed by the non-arrival of the cement to the border of the box in all samples, in combination with the relatively low injection forces [40,56,57].…”

Section: Discussionsupporting

confidence: 58%

“…The materials were fully injectable, with a clinically relevant extrusion force ( Figure 3) [39,41] and did not show signs of filter pressing or phase separation. The injected cement exhibited a uniform ball-like shape (Figure 4), and while there is no literature data on specific sphericity values of CPC cements, it could be assumed that this shape would be beneficial in terms of a reduced risk for leakage in clinical applications such as vertebroplasty [55], as has been the hypothesis for PMMA cements [40,56,57].…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Changes in the drug release pattern of fresh and set simvastatin-loaded brushite cement

Mestres

Kugiejko

Pastorino

et al. 2016

Materials Science and Engineering: C

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Calcium phosphate cements are synthetic bone graft substitutes able to set at physiological conditions. They can be applied by minimally invasive surgery and can also be used as drug delivery systems.Consequently, the drug release pattern from the cement paste (fresh cement) is of high clinical interest.However, previous studies have commonly evaluated the drug release using pre-set cements only.Therefore, the aim of this work was to determine if the time elapsed from cement preparation until immersion in the solution (3 min for fresh cements, and 1 h and 15 h for pre-set cements) had an influence on its physical properties, and correlating these to the drug release profile. Simvastatin was selected as a model drug, while brushite cement was used as drug carrier. This study quantified how the setting of a material reduces the accessibility of the release media to the material, thus preventing drug release. A shift in the drug release pattern was observed, from a burst-release for fresh cements to a sustained release for pre-set cements.

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“…This was confirmed by the non-arrival of the cement to the border of the box in all samples, in combination with the relatively low injection forces [40,56,57].…”

Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 97%

Changes in the drug release pattern of fresh and set simvastatin-loaded brushite cement

Mestres

Kugiejko

Pastorino

et al. 2016

Materials Science and Engineering: C

View full text Add to dashboard Cite

show abstract

“…In order to minimize the risk of direct cement extrusion into the spinal canal through cortical defects or enlarged venous sinusoid, most authors who are experienced in performing vertebroplasty recommend that the PMMA be injected in a viscous or partially polymerized consistency through a large-bore needle [9]. In a biomechanical study, Bohner et al [8] used a theoretical model to determine the distribution of a PMMA cement after its injection into a porous structure, and then compared with experimental results. The model predicted that the extravasation risk was decreased when the cement viscosity, the bone pore size, the bone permeability and the bone porosity were increased, and when the diameter of the extravasation path and the viscosity of the marrow were decreased.…”

Section: Discussionmentioning

confidence: 99%

Revision strategies for complications and failure of vertebroplasties

Yang

Chen

et al. 2008

Eur Spine J

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Percutaneous vertebroplasty is widely discussed in the management of osteoporotic spinal compression fracture, but few reports are available concerning salvage procedures after failure of this technique. We studied 22 percutaneous vertebroplasty patients who required revision surgery upon presentation of new symptoms postoperatively. The indications for revision surgery included recurrent intractable back pain with no response to medical treatment, infectious spondylitis, cement leakage with neurologic deficit, and cement dislodgement and/ or fragmentation. Five patients underwent repeated percutaneous vertebroplasty of the initially cemented vertebrae. Seventeen patients underwent anterior, posterior, or combined anterior and posterior surgery. Four patients required a third surgical procedure because of poor augmentation with cement, subsidence of the anterior bone graft, or pullout of the instrumentation. Finally, four (18%) patients underwent repeat vertebroplasty, two (9%) patients underwent anterior surgery only, one (5%) patient underwent posterior surgery only, and 15 (68%) patients underwent combined anterior and posterior surgery; all but one regained ambulatory status equivalent to that prior to surgery. In conclusion, percutaneous vertebroplasty is a simple and effective, but not risk-or complication-free procedure for the treatment of osteoporotic spinal compression fracture. The spine surgeon should be familiar with varied approaches and techniques for revision surgery. Combined anterior and posterior surgery seems to be the most secure salvage method to treat severely osteoporotic patients in whom percutaneous vertebroplasty initially failed.

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“…Among them, extravasations of PMMA cement is the most prevalent and occurs in 11-81% of PVP cases described in the literature [1,2,4,5,7,9,13,22,27]. Although extravasations of PMMA cement could be reduced by increase of the cement viscosity [3] and are usually of little clinical consequence [7,8,25,27], it can result in severe neurologic complications that require surgical decompression [7,17,[20][21][22][23][24]26].…”

Section: Introductionmentioning

confidence: 99%

Surgical removal of extravasated epidural and neuroforaminal polymethylmethacrylate after percutaneous vertebroplasty in the thoracic spine

Lin

Yang

et al. 2006

Eur Spine J

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Although extravasations of polymethylmetharylate during percutaneous vertebroplasty are usually of little clinical consequence, surgical decompression is occasionally required if resultant neurologic deficits are severe. Surgical removal of epidural polymethylmetharylate is usually necessary to achieve good neurologic recovery. Because mobilizing the squeezed spinal cord in a compromised canal can cause further deterioration, attempts to remove epidural polymethylmetharylate in the thoracic region need special consideration. A 66-year-old man had incomplete paraparesis and radicular pain on the chest wall after percutaneous vertebroplasty for osteoporotic compression fracture of T7. Radiological studies revealed polymethylmetharylate extravasations into the right lateral aspect of spinal canal that caused marked encroachment of the thecal sac and right neuroforamina. Progressive neurologic deficit and poor responses to medical managements were observed; therefore, surgical decompression was performed 4 months later.After laminectomy and removal of facet joints and T7 pedicle on the affected side, extravasated polymethylmetharylate posterior and anterior to the thecal sac was completely removed without retracting the dura mater. Spinal stability was reconstructed by supplemental spinal instrumentation and intertransverse arthrodesis with banked cancellous allografts. Myelopathy and radicular pain gradually resolved after decompression surgery. The patient was free of sensory abnormality and regained satisfactory ambulation two years after surgical decompression.

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Theoretical and experimental model to describe the injection of a polymethylmethacrylate cement into a porous structure

Cited by 180 publications

References 13 publications

Changes in the drug release pattern of fresh and set simvastatin-loaded brushite cement

Changes in the drug release pattern of fresh and set simvastatin-loaded brushite cement

Revision strategies for complications and failure of vertebroplasties

Surgical removal of extravasated epidural and neuroforaminal polymethylmethacrylate after percutaneous vertebroplasty in the thoracic spine

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