How the clinical dosage of bone cement biomechanically affects adjacent vertebrae
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(2020) 15:370
RESEARCH ARTICLE
Open Access
How the clinical dosage of bone cement biomechanically affects adjacent vertebrae Xu-shi Chen1, Jian-ming Jiang2, Pei-dong Sun3, Zhao-fei Zhang4* and Hai-long Ren2*
Abstract Objective: This study evaluated the biomechanical changes in the adjacent vertebrae under a physiological load (500 N) when the clinically relevant amount of bone cement was injected into fractured cadaver vertebral bodies. Methods: The embalmed cadaver thoracolumbar specimens in which each vertebral body (T12–L2) had a BMD of < 0.75 g/cm2 were used for the experiment. For establishing a fracture model, the upper one third of the L1 vertebra was performed wedge osteotomy and the superior endplate was kept complete. Stiffness of specimens was measured in different states. Strain of the adjacent vertebral body and intervertebral disc were measured in pre-fracture, post-fracture, and after augmentation by non-contact optical strain measurement system. Results: The average amount of bone cement was 4.4 ml (3.8–5.0 ml). The stiffness of after augmentation was significantly higher than the stiffness of post-fracture (p < 0.05), but still lower than pre-fracture stiffness (p < 0.05). After augmentation, the adjacent upper vertebral strain showed no significant difference (p > 0.05) with prefracture, while the strain of adjacent lower vertebral body was significantly higher than that before fracture (p < 0.05). In flexion, T12/L1 intervertebral disc strain was significantly greater after augmentation than after the fracture (p < 0.05), but there was no significant difference from that before the fracture (p > 0.05); L1/2 vertebral strain after augmentation was significantly less than that after the fracture (p < 0.05), but there was no significant difference from that before the fracture (p > 0.05). Conclusions: PVP may therefore have partially reversed the abnormal strain state of adjacent vertebral bodies which was caused by fracture. Keywords: Osteoporotic vertebral compression fracture, Percutaneous vertebroplasty, Stiffness, Strain
Introduction Percutaneous vertebroplasty (PVP) was an effective treatment for patients with osteoporotic vertebral compression fractures when conservative treatment is ineffective. Clinical studies have shown, however, that new vertebral compression fractures occur in some patients who have undergone PVP. The reported * Correspondence: [email protected]; [email protected] 4 Department of Orthopedic Surgery, Guangzhou Hospital of Integrated Traditional and Western Medicine, 87 Yingbin Road, Huadu District, Guangzhou, Guangdong, China 2 Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China Full list of author information is available at the end of the article
incidence of these new vertebral compression fractures (including both adjacent and non-adjacent segments) after PVP has ranged widely (5.5–33.5%), with compression fractures of adjacent segments becoming more common [1–3]. Most authors attributed the new fractures to
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