Improved biomechanics of two alternative kyphoplasty cementation methods limit vertebral recollapse

Todd Alamin, John P. Kleimeyer, James R. Woodall, Vijay Agarwal, Angus Don, Derek Lindsey

Research output: Contribution to journalArticle

Abstract

The clinical efficacy of vertebral cement augmentation for compression fractures (VCFs) remains undetermined. Recent studies have shown that refracture and progression of deformity may occur after augmentation with significant clinical consequences. Vertebral body height loss following kyphoplasty has also been observed with cyclic loading. We hypothesized that height loss is partly due to lack of cement fill past the margin of cancellous bone created by balloon expansion with subsequent failure under load. The biomechanical characteristics of two alternative cementation techniques were compared to standard kyphoplasty in cyclically loaded cadaveric VCF constructs. Sectioned osteoporotic thoracolumbar cadaveric spines were compressed to 75% of anterior vertebral height. Specimens were then allocated to standard kyphoplasty, balloon pressurization (BP), with reinflation of the balloon after 50% cement injection, or endplate post (EP), with perforation of the cavity rim using an articulating curette prior to injection. Following cementation, each specimen was preconditioned and loaded over 100,000 cycles. All techniques improved vertebral height (p's < 0.005). The EP and BP techniques provided greater cement fill than the standard technique (p's ≤ 0.01). Normalized vertebral height loss following 100,000 cycles was reduced with the EP technique versus standard kyphoplasty (p < 0.04). Height loss was inversely correlated with cement fill (p < 0.03). No vertebral recollapse occurred with the EP technique in blinded radiographic analysis. Statement of clinical significance: The EP technique demonstrated improved biomechanical characteristics versus the standard technique in cadaveric osteoporotic VCF constructs with decreased recollapse following cementation. This technique may have increased efficacy in cases when kyphoplasty more substantially improves vertebral body height.

Original languageEnglish (US)
Pages (from-to)3225-3230
Number of pages6
JournalJournal of Orthopaedic Research
Volume36
Issue number12
DOIs
StatePublished - Dec 2018
Externally publishedYes

Fingerprint

Kyphoplasty
Cementation
Biomechanical Phenomena
Post and Core Technique
Compression Fractures
Body Height
Injections
Spine

Keywords

  • biomechanics
  • cement augmentation
  • cyclic loading
  • kyphoplasty technique
  • Osteoporotic vertebral compression fracture

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Improved biomechanics of two alternative kyphoplasty cementation methods limit vertebral recollapse. / Alamin, Todd; Kleimeyer, John P.; Woodall, James R.; Agarwal, Vijay; Don, Angus; Lindsey, Derek.

In: Journal of Orthopaedic Research, Vol. 36, No. 12, 12.2018, p. 3225-3230.

Research output: Contribution to journalArticle

Alamin, Todd ; Kleimeyer, John P. ; Woodall, James R. ; Agarwal, Vijay ; Don, Angus ; Lindsey, Derek. / Improved biomechanics of two alternative kyphoplasty cementation methods limit vertebral recollapse. In: Journal of Orthopaedic Research. 2018 ; Vol. 36, No. 12. pp. 3225-3230.
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abstract = "The clinical efficacy of vertebral cement augmentation for compression fractures (VCFs) remains undetermined. Recent studies have shown that refracture and progression of deformity may occur after augmentation with significant clinical consequences. Vertebral body height loss following kyphoplasty has also been observed with cyclic loading. We hypothesized that height loss is partly due to lack of cement fill past the margin of cancellous bone created by balloon expansion with subsequent failure under load. The biomechanical characteristics of two alternative cementation techniques were compared to standard kyphoplasty in cyclically loaded cadaveric VCF constructs. Sectioned osteoporotic thoracolumbar cadaveric spines were compressed to 75{\%} of anterior vertebral height. Specimens were then allocated to standard kyphoplasty, balloon pressurization (BP), with reinflation of the balloon after 50{\%} cement injection, or endplate post (EP), with perforation of the cavity rim using an articulating curette prior to injection. Following cementation, each specimen was preconditioned and loaded over 100,000 cycles. All techniques improved vertebral height (p's < 0.005). The EP and BP techniques provided greater cement fill than the standard technique (p's ≤ 0.01). Normalized vertebral height loss following 100,000 cycles was reduced with the EP technique versus standard kyphoplasty (p < 0.04). Height loss was inversely correlated with cement fill (p < 0.03). No vertebral recollapse occurred with the EP technique in blinded radiographic analysis. Statement of clinical significance: The EP technique demonstrated improved biomechanical characteristics versus the standard technique in cadaveric osteoporotic VCF constructs with decreased recollapse following cementation. This technique may have increased efficacy in cases when kyphoplasty more substantially improves vertebral body height.",
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