The biomechanical evaluation of calcium phosphate cements for use in vertebroplasty

View More View Less
  • 1 Departments of Radiology and Neurosurgery, Guro Hospital, Korea University College of Medicine; Departments of Radiology and Orthopedic Surgery, Anam Hospital, Korea University College of Medicine; Department of Radiology, Kyung Hee University Hospital, Kyung Hee University College of Medicine; and Department of Cardiothoracic Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Korea
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The authors evaluate the biomechanical properties of vertebral bodies (VBs) stabilized with calcium phosphate (CaP) cements for use in vertebroplasty in comparison with polymethylmethacrylate (PMMA).

Methods

In the first phase of the study, 73 VBs (T3–L2; thoracic region [T3–8] and thoracolumbar region [T9–L2]) were collected from seven fresh human cadavers. Compression tests were performed before and after vertebroplasty using PMMA (compression strength 80 MPa) and three kinds of CaP cements—CaP1 (5 MPa), CaP2 (20 MPa), and CaP3 (50 MPa). The authors compared the maximal compression loads (MCLs) and stiffness before and after vertebroplasty in each of the four cement groups. In the second phase of the study, 18 paired spinal units (PSUs) were collected from three fresh human cadavers, and the authors injected two types of cement selected from the first phase of the study into the lower level of six PSUs. They compared the MCLs of the untreated and two treated groups (there were six PSUs in each type of group) to analyze the tendency of inducing compression fractures in the upper level of the PSUs.

The MCLs of the PMMA-injected vertebrae were significantly increased after vertebroplasty. The MCL levels of the CaP3-injected vertebrae and the CaP2-injected thoracolumbar vertebrae were decreased from those of untreated vertebrae without being significant. The MCLs of CaP1-injected vertebrae and CaP2-injected thoracic vertebrae were significantly decreased after vertebroplasty. The stiffness of all cement groups was decreased after vertebroplasty compared with initial stiffness, significantly so in all three thoracic CaP groups. In the second compression test with PSUs, the MCLs of the CaP2- and CaP3-injected PSUs were not significantly different from those of the untreated control PSUs.

Conclusions

The CaP3-injected vertebrae restored the MCLs of human vertebrae closer to their initial levels than the PMMA-injected vertebrae did. The CaP2- and CaP3-injected PSUs showed no tendency to induce compression fractures in adjacent VBs.

Abbreviations used in this paper: BMD = bone mineral density; CaP = calcium phosphate; FSU = functional spinal unit; MCL = maximal compression load; PMMA = polymethylmethacrylate; PSU = paired spinal unit; SD = standard deviation; TCP = tricalcium phosphate; VB = vertebral body.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Youn-Kwan Park, M.D., Ph.D., Department of Neurosurgery, Korea University Guro Hospital, Guro-gu, Guro-dong 80, Seoul 152-703, Korea. email: ykapa@kumc.or.kr.
  • 1

    Barr JD, , Barr MS, , Lemley TJ, & McCann RM: Percutaneous vertebroplasty for pain relief and spinal stabilization. Spine 25:923928, 2000

  • 2

    Belkoff SM, , Mathis JM, , Erbe EM, & Fenton DC: Biomechanical evaluation of a new bone cement for use in vertebroplasty. Spine 25:10611064, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Belkoff SM, , Mathis JM, & Jasper LE: Ex vivo biomechanical comparison of hydroxyapatite and polymethylmethacrylate cements for use with vertebroplasty. AJNR Am J Neuroradiol 23:16471651, 2002

    • Search Google Scholar
    • Export Citation
  • 4

    Belkoff SM, , Mathis JM, , Jasper LE, & Deramond H: The biomechanics of vertebroplasty. The effect of cement volume on mechanical behavior. Spine 26:15371541, 2001

    • Search Google Scholar
    • Export Citation
  • 5

    Belkoff SM, , Mathis JM, , Jasper LE, & Deramond H: An ex vivo biomechanical evaluation of a hydroxyapatite cement for use with vertebroplasty. Spine 26:15421546, 2001

    • Search Google Scholar
    • Export Citation
  • 6

    Berlemann U, , Ferguson SJ, , Nolte LP, & Heini PF: Adjacent vertebral failure after vertebroplasty. A biomechanical investigation. J Bone Joint Surg (Br) 84:748752, 2002

    • Search Google Scholar
    • Export Citation
  • 7

    Bürklein D, , Lochmüller EM, , Kuhn V, , Grimm J, , Barkmann R, & Müller R, : Correlation of thoracic and lumbar vertebral failure loads with in situ vs. ex situ dual energy X-ray absorptiometry. J Biomech 34:579587, 2001

    • Search Google Scholar
    • Export Citation
  • 8

    Cortet B, , Cotten A, , Boutry N, , Flipo RM, , Duquesnoy B, & Chastanet P, : Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. J Rheumatol 26:22222228, 1999

    • Search Google Scholar
    • Export Citation
  • 9

    Cotten A, , Boutry N, , Cortet B, , Assaker R, , Demondion X, & Le-blond D, : Percutaneous vertebroplasty: state of the art. Radiographics 18:311320, 1998

    • Search Google Scholar
    • Export Citation
  • 10

    Cunin G, , Boissonnet H, , Petite H, , Blanchat C, & Guillemin G: Experimental vertebroplasty using osteoconductive granular material. Spine 25:10701076, 2000

    • Search Google Scholar
    • Export Citation
  • 11

    Deramond H, , Depriester C, , Galibert P, & Le Gars D: Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. Radiol Clin North Am 36:533546, 1998

    • Search Google Scholar
    • Export Citation
  • 12

    Grados F, , Depriester C, , Cayrolle G, , Hardy N, , Deramond H, & Fardellone P: Long-term observations of vertebral osteoporotic fractures treated by percutaneous vertebroplasty. Rheumatology 39:14101414, 2000

    • Search Google Scholar
    • Export Citation
  • 13

    Heini PF, & Berlemann U: Bone substitutes in vertebroplasty. Eur Spine J 10 :Suppl 2 S205S213, 2001

  • 14

    Heini PF, , Berlemann U, , Kaufmann M, , Lippuner K, , Fankhauser C, & van Landuyt P: Augmentation of mechanical properties in osteoporotic vertebral bones—a biomechanical investigation of vertebroplasty efficacy with different bone cements. Eur Spine J 10:164171, 2001

    • Search Google Scholar
    • Export Citation
  • 15

    Heini PF, , Walchli B, & Berlemann U: Percutaneous transpedicular vertebroplasty with PMMA: operative technique and early results. A prospective study for the treatment of osteoporotic compression fractures. Eur Spine J 9:445450, 2000

    • Search Google Scholar
    • Export Citation
  • 16

    Jensen ME, , Evans AJ, , Mathis JM, , Kallmes DF, , Cloft HJ, & Dion JE: Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: technical aspects. AJNR Am J Neuroradiol 18:18971904, 1997

    • Search Google Scholar
    • Export Citation
  • 17

    Lim TH, , Brebach GT, , Renner SM, , Kim WJ, , Kim JG, & Lee RE, : Biomechanical evaluation of an injectable calcium phosphate cement for vertebroplasty. Spine 27:12971302, 2002

    • Search Google Scholar
    • Export Citation
  • 18

    Mathis JM, , Barr JD, , Belkoff SM, , Barr MS, , Jensen ME, & Deramond H: Percutaneous vertebroplasty: A developing standard of care for vertebral compression fractures. AJNR Am J Neuroradiol 22:373381, 2001

    • Search Google Scholar
    • Export Citation
  • 19

    McGraw JK, , Cardella J, , Barr JD, , Mathis JM, , Sanchez O, & Schwartzberg MS, : Society of Interventional Radiology quality improvement guidelines for percutaneous vertebroplasty. J Vasc Interv Radiol 14:827831, 2003

    • Search Google Scholar
    • Export Citation
  • 20

    McGraw JK, , Lippert JA, , Minkus KD, , Rami PM, , Davis TM, & Budzik RF: Prospective evaluation of pain relief in 100 patients undergoing percutaneous vertebroplasty: results and follow-up. J Vasc Interv Radiol 13:883886, 2001

    • Search Google Scholar
    • Export Citation
  • 21

    Ohura K, , Bohner M, , Hardouin P, , Lemaitre J, , Pasquier G, & Flautre B: Resorption of, and bone formation from, new β-tricalcium phosphate-monocalcium phosphate cements: an in vivo study. J Biomed Mater Res 30:193200, 1996

    • Search Google Scholar
    • Export Citation
  • 22

    Perez-Higueras A, , Alvarez L, , Rossi RE, , Quinones D, & Al-Assir I: Percutaneous vertebroplasty: long-term clinical and radiological outcome. Neuroradiology 44:950954, 2002

    • Search Google Scholar
    • Export Citation
  • 23

    Uppin AA, , Hirsch JA, , Centenera LV, , Pfiefer BA, , Pazianos AG, & Choi IS: Occurrence of new vertebral body fracture after percutaneous vertebroplasty in patients with osteoporosis. Radiology 226:119124, 2003

    • Search Google Scholar
    • Export Citation
  • 24

    Zoarski GH, , Snow P, , Olan WJ, , Stallmeyer MJB, , Dick BW, & Hebel JR, : Percutaneous vertebroplasty for osteoporotic compression fractures: quantitative prospective evaluation of long-term outcomes. J Vasc Interv Radiol 13:139148, 2002

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 154 74 3
Full Text Views 66 9 3
PDF Downloads 38 6 1
EPUB Downloads 0 0 0