Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies

Luo, Jin ORCID: https://orcid.org/0000-0001-5451-9535, Daines, L, Charalambous, A, Adams, MA, Annesley-Williams, DJ and Dolan, P (2009) Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine, 34 (26). pp. 2865-2873. ISSN 0362-2436

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Abstract

Study Design.

Biomechanical study of vertebroplasty in cadaver motion segments.

Objectives.

To determine how the volume of injected cement influences: (a) stress distributions on fractured and adjacent vertebral bodies, (b) load-sharing between the vertebral bodies and neural arch, and (c) cement leakage.

Summary of Background Data.

Vertebroplasty is increasingly used to treat vertebral fractures, but there are problems concerning adjacent level fracture and cement leakage, both of which may depend on the volume of injected cement.

Methods.

Nineteen thoracolumbar motion segments from 13 cadavers (42–91 years) were loaded to induce fracture. Fractured vertebrae received 2 sequential injections (VP1 and VP2) of 3.5 cm3 of polymethylmethacrylate cement. Before and after each intervention, motion segment stiffness was measured in compression and in bending, and “stress profilometry” was used to quantify the distribution of compressive stress in the intervertebral disc (which presses equally on fractured and adjacent vertebrae). Stress profiles were obtained by pulling a pressure transducer through the disc while the motion segment was compressed in flexed and extended postures. Stress profiles yielded the intradiscal pressure (IDP), the magnitude of stress peaks in the anterior and posterior (SPP) anulus, and the percentage of the applied compressive force resisted by the neural arch (FN). Cement leakage and vertebral body volume were quantified using water-immersion, and the percentage cement fill was estimated.

Results.

Bending and compressive stiffness fell by 37% and 50% respectively following fracture, and were restored only after VP2. Depending on posture, IDP fell by 59–85% after fracture whereas SPP increased by 107– 362%. VP1 restored IDP and SPP to prefracture values, and VP2 produced no further changes. Fracture increased FN from 11% to 39% in flexion, and from 33% to 59% in extension. FN was restored towards prefracture values only after VP2. Cement leakage increased after VP2 and was negatively correlated to vertebral body volume. Following VP2, increases in IDP and compressive stiffness were proportional to percentage fill.

Conclusion.

About 3.5 cm3 of PMMA largely restored normal stress distributions to fractured and adjacent vertebral bodies, but 7 cm3 were required to restore motion segment stiffness and load-sharing between the vertebral bodies and neural arch. Cement leakage, IDP and compressive stiffness all increased with percentage fill.

Item Type: Article
Additional Information: Luo, Jin, BSc, PhD*; Daines, Luke, BSc*; Charalambous, Alexander, BSc*; Adams, Michael A., BSc, PhD*; Annesley-Williams, Deborah J., FRCR†; Dolan, Patricia, BSc, PhD* Vertebroplasty: Only Small Cement Volumes Are Required to Normalize Stress Distributions on the Vertebral Bodies, Spine: December 15, 2009 - Volume 34 - Issue 26 - p 2865-2873 doi: 10.1097/BRS.0b013e3181b4ea1e
Uncontrolled Keywords: vertebroplasty, cement volume, load-sharing, intradiscal pressure, vertebral fracture
Subjects: Construction and engineering > Biomedical engineering
Medicine and health > Clinical medicine > Therapeutics
Medicine and health > Clinical medicine
Medicine and health
Related URLs:
Depositing User: Jin Luo
Date Deposited: 08 May 2020 22:38
Last Modified: 09 May 2020 14:08
URI: http://repository.uwl.ac.uk/id/eprint/6915

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