Local Osteo-enhancement of Osteoporotic Vertebra with a Triphasic Bone Implant Material Increases Strength-a Biomechanical Study

Overview

Journal Arch Orthop Trauma Surg

Specialties Emergency Medicine
General Surgery
Orthopedics

Date 2020 Feb 29

PMID 32108254

Citations 6

Authors

Matthias Trost

Werner Schmoelz

Doris Wimmer

Romed Hormann

Sonke Frey

Tobias Ludger Schulte

Affiliations

Soon will be listed here.

Abstract

Purpose: The aim of this study was to assess the biomechanical properties of intact vertebra augmented using a local osteo-enhancement procedure to inject a triphasic calcium sulfate/calcium phosphate implant material.

Methods: Twenty-one fresh frozen human cadaver vertebra (Th11-L2) were randomized into three groups: treatment, sham, and control (n = 7 each). Treatment included vertebral body access, saline lavage to displace soft tissue and marrow elements, and injection of the implant material to fill approximately 20% of the vertebral body by volume. The sham group included all treatment steps, but without injection of the implant material. The control group consisted of untreated intact osteoporotic vertebra. Load at failure and displacement at failure for each of the three groups were measured in axial compression loading.

Results: The mean failure load of treated vertebra (4118 N) was significantly higher than either control (2841 N) or sham (2186 N) vertebra (p < 0.05 for: treatment vs. control, treatment vs. sham). Treated vertebra (1.11 mm) showed a significantly higher mean displacement at failure than sham vertebra (0.80 mm) (p < 0.05 for: treatment vs. sham). In the control group, the mean displacement at failure was 0.99 mm.

Conclusions: This biomechanical study shows that a local osteo-enhancement procedure using a triphasic implant material significantly increases the load at failure and displacement at failure in cadaveric osteoporotic vertebra.

Citing Articles

Fabrication and mechanical properties of newly developed triphasic blocks composed of gypsum-brushite-monetite for bone graft applications.

Tadjoedin E, Sunarso Saudi Dent J. 2022; 34(8):757-762.

PMID: 36570579 PMC: 9767863. DOI: 10.1016/j.sdentj.2022.11.005.

Venous injection of a triphasic calcium-based implant in a sheep model of pulmonary embolism demonstrates minimal acute systemic effects.

Constant C, Stroncek J, Zeiter S, Arens D, Nehrbass D, Gehweiler D Eur Spine J. 2022; 31(10):2812-2821.

PMID: 35976438 DOI: 10.1007/s00586-022-07303-x.

Gaps and alternative surgical and non-surgical approaches in the bone fragility management: an updated review.

Tarantino U, Cariati I, Greggi C, Iundusi R, Gasbarra E, Iolascon G Osteoporos Int. 2022; 33(12):2467-2478.

PMID: 35851407 DOI: 10.1007/s00198-022-06482-z.

Osteoporosis in 10 years time: a glimpse into the future of osteoporosis.

Adami G, Fassio A, Gatti D, Viapiana O, Benini C, Danila M Ther Adv Musculoskelet Dis. 2022; 14:1759720X221083541.

PMID: 35342458 PMC: 8941690. DOI: 10.1177/1759720X221083541.

The accuracy and effectiveness of automatic pedicle screw trajectory planning based on computer tomography values: an in vitro osteoporosis model study.

Liu J, Zuo R, Zheng W, Li C, Zhang C, Zhou Y BMC Musculoskelet Disord. 2022; 23(1):165.

PMID: 35189892 PMC: 8862578. DOI: 10.1186/s12891-022-05101-6.

References

Al-Sari U, Tobias J, Clark E . Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int. 2016; 27(10):2891-900. DOI: 10.1007/s00198-016-3648-x. View

Chen L, Li Y, Ning G, Li Y, Wu Q, Guo J . Comparative efficacy and tolerability of three treatments in old people with osteoporotic vertebral compression fracture: a network meta-analysis and systematic review. PLoS One. 2015; 10(4):e0123153. PMC: 4395314. DOI: 10.1371/journal.pone.0123153. View

Black D, Arden N, Palermo L, Pearson J, Cummings S . Prevalent vertebral deformities predict hip fractures and new vertebral deformities but not wrist fractures. Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1999; 14(5):821-8. DOI: 10.1359/jbmr.1999.14.5.821. View

Delmas P, Genant H, Crans G, Stock J, Wong M, Siris E . Severity of prevalent vertebral fractures and the risk of subsequent vertebral and nonvertebral fractures: results from the MORE trial. Bone. 2003; 33(4):522-32. DOI: 10.1016/s8756-3282(03)00241-2. View

Sanderson J, Martyn-St James M, Stevens J, Goka E, Wong R, Campbell F . Clinical effectiveness of bisphosphonates for the prevention of fragility fractures: A systematic review and network meta-analysis. Bone. 2016; 89:52-58. DOI: 10.1016/j.bone.2016.05.013. View

Saito T, Sterbenz J, Malay S, Zhong L, MacEachern M, Chung K . Effectiveness of anti-osteoporotic drugs to prevent secondary fragility fractures: systematic review and meta-analysis. Osteoporos Int. 2017; 28(12):3289-3300. DOI: 10.1007/s00198-017-4175-0. View

Viswanathan M, Reddy S, Berkman N, Cullen K, Middleton J, Nicholson W . Screening to Prevent Osteoporotic Fractures: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018; 319(24):2532-2551. DOI: 10.1001/jama.2018.6537. View

Kanis J, Cooper C, Rizzoli R, Reginster J . European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int. 2018; 30(1):3-44. PMC: 7026233. DOI: 10.1007/s00198-018-4704-5. View

Stroncek J, Shaul J, Favell D, Hill R, Huber B, Howe J . In vitro injection of osteoporotic cadaveric femurs with a triphasic calcium-based implant confers immediate biomechanical integrity. J Orthop Res. 2019; 37(4):908-915. PMC: 6593990. DOI: 10.1002/jor.24239. View

10.

Schmoelz W, Disch A, Huber J . Vertebroplasty with self-locking hexagonal metal implants shows comparable primary and secondary stiffness to PMMA cement augmentation techniques in a biomechanical vertebral compression fracture model. Eur Spine J. 2010; 19(6):1029-36. PMC: 2899983. DOI: 10.1007/s00586-010-1342-9. View

11.

Belkoff S, Maroney M, Fenton D, Mathis J . An in vitro biomechanical evaluation of bone cements used in percutaneous vertebroplasty. Bone. 1999; 25(2 Suppl):23S-26S. DOI: 10.1016/s8756-3282(99)00128-3. View

12.

Schulte T, Keiler A, Riechelmann F, Lange T, Schmoelz W . Biomechanical comparison of vertebral augmentation with silicone and PMMA cement and two filling grades. Eur Spine J. 2013; 22(12):2695-701. PMC: 3843779. DOI: 10.1007/s00586-013-2908-0. View

13.

Hoppe S, Elfiky T, Keel M, Aghayev E, Ecker T, Benneker L . Lavage prior to vertebral augmentation reduces the risk for cement leakage. Eur Spine J. 2015; 25(11):3463-3469. DOI: 10.1007/s00586-015-4191-8. View

14.

Martincic D, Brojan M, Kosel F, Stern D, Vrtovec T, Antolic V . Minimum cement volume for vertebroplasty. Int Orthop. 2014; 39(4):727-33. DOI: 10.1007/s00264-014-2620-7. View

15.

Boger A, Heini P, Windolf M, Schneider E . Adjacent vertebral failure after vertebroplasty: a biomechanical study of low-modulus PMMA cement. Eur Spine J. 2007; 16(12):2118-25. PMC: 2140124. DOI: 10.1007/s00586-007-0473-0. View

16.

McGirt M, Parker S, Wolinsky J, Witham T, Bydon A, Ziya L Gokaslan . Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J. 2009; 9(6):501-8. DOI: 10.1016/j.spinee.2009.01.003. View

17.

Benneker L, Krebs J, Boner V, Boger A, Hoerstrup S, Heini P . Cardiovascular changes after PMMA vertebroplasty in sheep: the effect of bone marrow removal using pulsed jet-lavage. Eur Spine J. 2010; 19(11):1913-20. PMC: 2989274. DOI: 10.1007/s00586-010-1555-y. View

18.

Li C, Pan J, Gu Y, Dong J . Minimally invasive pedicle screw fixation combined with percutaneous vertebroplasty for the treatment of thoracolumbar burst fracture. Int J Surg. 2016; 36(Pt A):255-260. DOI: 10.1016/j.ijsu.2016.11.003. View

19.

Kao F, Hsieh M, Yu C, Tsai T, Lai P, Niu C . Additional vertebral augmentation with posterior instrumentation for unstable thoracolumbar burst fractures. Injury. 2017; 48(8):1806-1812. DOI: 10.1016/j.injury.2017.06.015. View

20.

Jia P, Tang H, Chen H, Bao L, Feng F, Yang H . Prophylactic vertebroplasty procedure applied with a resorbable bone cement can decrease the fracture risk of sandwich vertebrae: long-term evaluation of clinical outcomes. Regen Biomater. 2017; 4(1):47-53. PMC: 5274705. DOI: 10.1093/rb/rbw037. View