Comparison of the biomechanics of hydroxyapatite and polymethylmethacrylate vertebroplasty in a cadaveric spinal compression fracture model

Patrick W. HitchonDivision of Neurosurgery, and Departments of Biomedical Engineering and Epidemiology, University of Iowa and Veterans Administration Medical Center, Iowa City, Iowa

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Vijay GoelDivision of Neurosurgery, and Departments of Biomedical Engineering and Epidemiology, University of Iowa and Veterans Administration Medical Center, Iowa City, Iowa

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John DrakeDivision of Neurosurgery, and Departments of Biomedical Engineering and Epidemiology, University of Iowa and Veterans Administration Medical Center, Iowa City, Iowa

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Derek TaggardDivision of Neurosurgery, and Departments of Biomedical Engineering and Epidemiology, University of Iowa and Veterans Administration Medical Center, Iowa City, Iowa

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Matthew BrentonDivision of Neurosurgery, and Departments of Biomedical Engineering and Epidemiology, University of Iowa and Veterans Administration Medical Center, Iowa City, Iowa

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Thomas RoggeDivision of Neurosurgery, and Departments of Biomedical Engineering and Epidemiology, University of Iowa and Veterans Administration Medical Center, Iowa City, Iowa

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James C. TornerDivision of Neurosurgery, and Departments of Biomedical Engineering and Epidemiology, University of Iowa and Veterans Administration Medical Center, Iowa City, Iowa

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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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