Does the cement stiffness affect fatigue fracture strength of vertebrae after cement augmentation in osteoporotic patients?
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Does the cement stiffness affect fatigue fracture strength of vertebrae after cement augmentation in osteoporotic patients? / Kolb, Jan Philipp; Kueny, Rebecca A; Püschel, Klaus; Boger, Andreas; Rueger, Johannes M; Morlock, Michael M; Huber, Gerd; Lehmann, Wolfgang.
in: EUR SPINE J, Jahrgang 22, Nr. 7, 01.07.2013, S. 1650-6.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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T1 - Does the cement stiffness affect fatigue fracture strength of vertebrae after cement augmentation in osteoporotic patients?
AU - Kolb, Jan Philipp
AU - Kueny, Rebecca A
AU - Püschel, Klaus
AU - Boger, Andreas
AU - Rueger, Johannes M
AU - Morlock, Michael M
AU - Huber, Gerd
AU - Lehmann, Wolfgang
PY - 2013/7/1
Y1 - 2013/7/1
N2 - PURPOSE: Normal progression of osteoporosis or the rigid reinforcement of the fractured vertebral body with polymethyl methacrylate (PMMA) cement is being discussed as a cause for adjacent-level fractures after vertebroplasty. The purpose of this study was to investigate whether augmentation with low stiffness cement can decrease the risk of adjacent-level fractures in low-quality bone.METHODS: Eighteen female osteoporotic lumbar specimens (L1-L5) were harvested and divided into three groups according to bone mineral density: (I) native; (II) PMMA; (III) modified PMMA (lower stiffness). For the PMMA and modified PMMA groups, a compression fracture was first mechanically induced in L3, and then the fracture received vertebroplasty treatment. The cement stiffness reduction of the modified PMMA group was achieved via an addition of 8 mL of serum to the typical PMMA base. All specimens were exposed to cyclic loading (4 Hz) and a stepwise increasing applied peak force. Cement stiffness was tested according to ISO 5833.RESULTS: A 51% decrease in cement stiffness was achieved in the modified PMMA group (954 ± 141 vs. 1,937 ± 478 MPa, p < 0.001). Fatigue fracture force (the force level during cyclic loading at which the deformation experienced a sudden increase; FFF) was significantly affected by bone quality (r (2) = 0.39, p = 0.006) and by the initial fracture force (the force necessary to create the initial fracture in L3 prior to augmentation; r (2) = 0.82, p < 0.001). Using initial fracture force as a covariate, the FFF of the modified PMMA group (1,764 ± 49 N) was significantly higher than in the PMMA group (1,544 ± 55 N; p = 0.03).CONCLUSIONS: A possible method to reduce adjacent-level fractures after vertebroplasty in patients with reduced bone quality could be the use of a lower modulus cement. Therefore, mixing cement with biocompatible fluids could prove useful to tailor cement properties in the operating theater.
AB - PURPOSE: Normal progression of osteoporosis or the rigid reinforcement of the fractured vertebral body with polymethyl methacrylate (PMMA) cement is being discussed as a cause for adjacent-level fractures after vertebroplasty. The purpose of this study was to investigate whether augmentation with low stiffness cement can decrease the risk of adjacent-level fractures in low-quality bone.METHODS: Eighteen female osteoporotic lumbar specimens (L1-L5) were harvested and divided into three groups according to bone mineral density: (I) native; (II) PMMA; (III) modified PMMA (lower stiffness). For the PMMA and modified PMMA groups, a compression fracture was first mechanically induced in L3, and then the fracture received vertebroplasty treatment. The cement stiffness reduction of the modified PMMA group was achieved via an addition of 8 mL of serum to the typical PMMA base. All specimens were exposed to cyclic loading (4 Hz) and a stepwise increasing applied peak force. Cement stiffness was tested according to ISO 5833.RESULTS: A 51% decrease in cement stiffness was achieved in the modified PMMA group (954 ± 141 vs. 1,937 ± 478 MPa, p < 0.001). Fatigue fracture force (the force level during cyclic loading at which the deformation experienced a sudden increase; FFF) was significantly affected by bone quality (r (2) = 0.39, p = 0.006) and by the initial fracture force (the force necessary to create the initial fracture in L3 prior to augmentation; r (2) = 0.82, p < 0.001). Using initial fracture force as a covariate, the FFF of the modified PMMA group (1,764 ± 49 N) was significantly higher than in the PMMA group (1,544 ± 55 N; p = 0.03).CONCLUSIONS: A possible method to reduce adjacent-level fractures after vertebroplasty in patients with reduced bone quality could be the use of a lower modulus cement. Therefore, mixing cement with biocompatible fluids could prove useful to tailor cement properties in the operating theater.
KW - Biomechanical Phenomena
KW - Bone Cements
KW - Cadaver
KW - Female
KW - Hardness
KW - Humans
KW - Materials Testing
KW - Osteoporotic Fractures
KW - Spinal Fractures
U2 - 10.1007/s00586-013-2809-2
DO - 10.1007/s00586-013-2809-2
M3 - SCORING: Journal article
C2 - 23677522
VL - 22
SP - 1650
EP - 1656
JO - EUR SPINE J
JF - EUR SPINE J
SN - 0940-6719
IS - 7
ER -