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Patrick W. Hitchon, Vijay Goel, John Drake, Derek Taggard, Matthew Brenton, Thomas Rogge and James C. Torner

Object. Polymethylmethacrylate (PMMA) has long been used in the stabilization and reconstruction of traumatic and pathological fractures of the spine. Recently, hydroxyapatite (HA), an osteoconductive, biocompatible cement, has been used as an alternative to PMMA. In this study the authors compare the stabilizing effects of the HA product, BoneSource, with PMMA in an experimental compression fracture of L-1.

Methods. Twenty T9—L3 cadaveric spine specimens were mounted individually on a testing frame. Light-emitting diodes were placed on the neural arches as well as the base. Motion was tracked by two video cameras in response to applied loads of 0 to 6 Nm. The weight-drop technique was used to induce a reproducible compression fracture of T-11 after partially coring out the vertebra. Load testing was performed on the intact spine, postfracture, after unilateral transpedicular vertebroplasty with 7 to 10 ml of PMMA or HA, and after flexion—extension fatiguing to 5000 cycles at ± 3 Nm.

No significant difference between the HA- and PMMA cemented—fixated spines was demonstrated in flexion, extension, left lateral bending, or right and left axial rotation. The only difference between the two cements was encountered before and after fatiguing in right lateral bending (p ≤ 0.05).

Conclusions. The results of this study suggest that the same angular rigidity can be achieved using either HA or PMMA. This is of particular interest because HA is osteoconductive, undergoes remodeling, and is not exothermic.

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experience Henri-Dominique Fournier Philippe Mercier Philippe Menei October 2001 95 2 202 207 10.3171/spi.2001.95.2.0202 Effect of a prosthetic disc nucleus on the mobility and disc height of the L4–5 intervertebral disc postnucleotomy Hans-Joachim Wilke Sinead Kavanagh Sylvia Neller Christian Haid Lutz Eberhart Claes October 2001 95 2 208 214 10.3171/spi.2001.95.2.0208 Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model

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–1579, 1997 6. Hitchon PW , Goel V , Drake J , et al : Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model. J Neurosurg 95 (Spine 2) 95 : 215 – 220 , 2001 Hitchon PW, Goel V, Drake J, et al: Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model. J Neurosurg 95 (Spine 2) 95: 215–220, 2001 7. Kelly MF , Spiegel J , Rizzo KA

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Jon T. Ledlie and Mark Renfro

. This leads to an increased quality of life for these patients. Financial Disclosure An unrestricted 1-year (2000–2001) research grant from Kyphon, Inc., was received by Dr. Ledlie, who has no other financial interest in Kyphon, Inc. Dr. Renfro has no financial interest in Kyphon, Inc. References 1. Amar AP , Larsen DW , Esnaashari N , et al : Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49 : 1105 – 1115 , 2001 Amar AP

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Daryl R. Fourney, Donald F. Schomer, Remi Nader, Jennifer Chlan-Fourney, Dima Suki, Kamran Ahrar, Laurence D. Rhines and Ziya L. Gokaslan

: Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49 : 1105 – 1115 , 2001 Amar AP, Larsen DW, Esnaashari N, et al: Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49: 1105–1115, 2001 2. Barr JD , Barr MS , Lemley TJ , et al : Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25 : 923 – 928 , 2000 Barr JD, Barr MS, Lemley

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Scott Shapiro, Todd Abel and Scott Purvines

decompressive surgery and PMMA removal from the spinal canal are easy and can lead to immediate neurological improvement. References 1. Amar AP , Larsen DW , Esnaashari N , et al : Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49 : 1105 – 1115 , 2001 Amar AP, Larsen DW, Esnaashari N, et al: Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49: 1105–1115, 2001

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Jean-Valéry C. E. Coumans, Mary-Kay Reinhardt and Isador H. Lieberman

polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49 : 1105 – 1115 , 2001 Amar AP, Larsen DW, Esnaashari N, et al: Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49: 1105–1115, 2001 2. Bai B , Jazrawi LM , Kummer FJ , et al : The use of an injectable, biodegradable calcium phosphate bone substitute for the prophylactic augmentation of osteoporotic vertebrae and the management of vertebral compression

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Samuel Ryu, Jack Rock, Mark Rosenblum and Jae Ho Kim

cancer and thyroid medullary carcinoma. Following radiosurgery, they continued to experience the same level of persistent pain although there was no radiological sign of tumor progression. Pretreatment and postradiosurgery MR images and radiosurgery planning CT scans are shown in Fig. 1 . This patient underwent radiosurgery in which a 12-Gy dose was delivered. After 8 months, the tumor size appeared stable; however, a spinal compression fracture was suspected, which may have been the cause of persistent pain and possibly instability. Figure 2 shows the images

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Dachling Pang, Herman H. Tse, Marike Zwienenberg-Lee, Matthew Smith and John Zovickian

–81, 1999 11. Hitchon PW , Goel V , Drake J , Taggard D , Brenton M , Rogge T , et al : Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model. J Neurosurg (Spine) 95 : 215 – 220 , 2001 Hitchon PW, Goel V, Drake J, Taggard D, Brenton M, Rogge T, et al: Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model. J Neurosurg (Spine) 95: 215

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Stephen J. Hentschel, Allen W. Burton, Daryl R. Fourney, Laurence D. Rhines and Ehud Mendel

polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49 : 1105 – 1115 , 2001 Amar AP, Larsen DW, Esnaashari N, Albuquerque FC, Lavine SD, Teitelbaum GP: Percutaneous transpedicular polymethylmethacrylate vertebroplasty for the treatment of spinal compression fractures. Neurosurgery 49: 1105–1115, 2001 2. Barr JD , Barr MS , Lemley TJ , McCann RM : Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25 : 923 – 928 , 2000 Barr JD, Barr MS