Zementaugmentation an der Wirbelsäule: Was ist biomechanisch zu beachten?
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Zementaugmentation an der Wirbelsäule: Was ist biomechanisch zu beachten? / Kolb, J P; Weiser, L; Kueny, R A; Huber, G; Rueger, J M; Lehmann, W.
In: ORTHOPADE, Vol. 44, No. 9, 09.2015, p. 672-80.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Zementaugmentation an der Wirbelsäule: Was ist biomechanisch zu beachten?
AU - Kolb, J P
AU - Weiser, L
AU - Kueny, R A
AU - Huber, G
AU - Rueger, J M
AU - Lehmann, W
PY - 2015/9
Y1 - 2015/9
N2 - BACKGROUND: Vertebral compression fractures are the most common osteoporotic fractures. Since the introduction of vertebroplasty and screw augmentation, the management of osteoporotic fractures has changed significantly.AIMS: The biomechanical characteristics of the risk of adjacent fractures and novel treatment modalities for osteoporotic vertebral fractures, including pure cement augmentation by vertebroplasty, and cement augmentation of screws for posterior instrumentation, are explored.MATERIALS AND METHODS: Eighteen human osteoporotic lumbar spines (L1-5) adjacent to vertebral bodies after vertebroplasty were tested in a servo-hydraulic machine. As augmentation compounds we used standard cement and a modified low-strength cement. Different anchoring pedicle screws were tested with and without cement augmentation in another cohort of human specimens with a simple pull-out test and a fatigue test that better reflects physiological conditions.RESULTS: Cement augmentation in the osteoporotic spine leads to greater biomechanical stability. However, change in vertebral stiffness resulted in alterations with the risk of adjacent fractures. By using a less firm cement compound, the risk of adjacent fractures is significantly reduced. Both screw augmentation techniques resulted in a significant increase in the withdrawal force compared with the group without cement. Augmentation using perforated screws showed the highest stability in the fatigue test.DISCUSSION AND CONCLUSION: The augmentation of cement leads to a significant change in the biomechanical properties. Differences in the stability of adjacent vertebral bodies increase the risk of adjacent fractures, which could be mitigated by a modified cement compound with reduced strength. Screws that were specifically designed for cement application displayed greatest stability in the fatigue test.
AB - BACKGROUND: Vertebral compression fractures are the most common osteoporotic fractures. Since the introduction of vertebroplasty and screw augmentation, the management of osteoporotic fractures has changed significantly.AIMS: The biomechanical characteristics of the risk of adjacent fractures and novel treatment modalities for osteoporotic vertebral fractures, including pure cement augmentation by vertebroplasty, and cement augmentation of screws for posterior instrumentation, are explored.MATERIALS AND METHODS: Eighteen human osteoporotic lumbar spines (L1-5) adjacent to vertebral bodies after vertebroplasty were tested in a servo-hydraulic machine. As augmentation compounds we used standard cement and a modified low-strength cement. Different anchoring pedicle screws were tested with and without cement augmentation in another cohort of human specimens with a simple pull-out test and a fatigue test that better reflects physiological conditions.RESULTS: Cement augmentation in the osteoporotic spine leads to greater biomechanical stability. However, change in vertebral stiffness resulted in alterations with the risk of adjacent fractures. By using a less firm cement compound, the risk of adjacent fractures is significantly reduced. Both screw augmentation techniques resulted in a significant increase in the withdrawal force compared with the group without cement. Augmentation using perforated screws showed the highest stability in the fatigue test.DISCUSSION AND CONCLUSION: The augmentation of cement leads to a significant change in the biomechanical properties. Differences in the stability of adjacent vertebral bodies increase the risk of adjacent fractures, which could be mitigated by a modified cement compound with reduced strength. Screws that were specifically designed for cement application displayed greatest stability in the fatigue test.
U2 - 10.1007/s00132-015-3134-8
DO - 10.1007/s00132-015-3134-8
M3 - SCORING: Zeitschriftenaufsatz
C2 - 26193968
VL - 44
SP - 672
EP - 680
JO - ORTHOPADE
JF - ORTHOPADE
SN - 0085-4530
IS - 9
ER -