Effect of vertebroplasty on the compressive strength of vertebral bodies

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• 作者：Spiros G. Pneumaticos ; Georgios K. Triantafyllopoulos ; Dimitrios S. Evangelopoulos ; John A. Hipp ; Michael H. Heggeness
• 关键词：Vertebroplasty ; Compressive strength ; Thoracic vertebrae ; Osteoporosis ; Polymethylmethacrylate
• 刊名：The Spine Journal
• 出版年：1 December, 2013
• 年：2013
• 卷：13
• 期：12
• 页码：1921-1927
• 全文大小：813 K

文摘

Background context

Percutaneous vertebroplasty has been used successfully for many years in the treatment of painful compressive vertebral fractures due to osteoporosis.

Purpose

To compare the effect of vertebroplasty on the compressive strength of unfractured vertebral bodies.

Study design

Biomechanical study on cadaveric thoracic vertebrae.

Methods

Forty vertebral bodies from four cadaveric thoracic spines were used for this experiment. Before testing, each thoracic spine was submitted to bone density testing and radiographic evaluation to rule out any obvious fractures. Under image intensification, 6 mL of a mixture of polymethylmethacrylate (PMMA) with barium (8 g of barium/40 g of PMMA) was injected into every other vertebral body of each spine specimen. After vertebroplasty, all soft tissues were dissected from the spine, and the vertebral bodies were separated and potted for mechanical testing. Testing to failure was performed using a combination of axial compression and anterior flexion moments. Two pneumatic cylinders applied anterior and posterior loads at a distance ratio of 4:3 relative to the anterior vertebral body wall, whereas two additional cylinders applied lateral loads, each at a constant rate of 200 N/s.

Results

The average failure loads for nonvertebroplasty specimens was 6724.02卤3291.70 N, whereas the specimens injected with PMMA failed at an average compressive force of 5770.50卤2133.72 N. No statistically significant difference in failure loads could be detected between intact specimens and those that had undergone vertebroplasty.

Conclusions

Under these specific loading conditions, no significant increase in compressive strength of the vertebral bodies could be documented. This suggests that some caution should be applied to the concept of 鈥減rophylactic鈥?vertebroplasty in patients at risk for fracture.