Biomechanics Study of Vertebroplasty
Date Issued
2010
Date
2010
Author(s)
Chiang, Chun-Kai
Abstract
Percutaneous vertebroplasty is one of surgical treatments for osteoporotic vertebral compressive fracture. During the surgery, bone cement is injected into the fractured vertebrae to recover its stability and strength. Although patients are quickly relieved of pain, the complications of vertebroplasty, including cement leakage and vertebral failure at the adjacent and the augmented level, could be devastating. The treatments for complications may increase medical expenditure. The objectives of this study are to investigate the mechanisms of vertebroplasty complications and to propose potential prevention strategies to improve the long term benefits of vertebroplasty.
In the study of adjacent vertebral failure, we found the weak vertebra and flexion compression are the two risk factors for of adjacent vertebral failure. The results of this research suggest that; restoring the natural lordotic posture and reducing the magnitude of external loading seem to be the best strategies to prevent adjacent vertebral failure for an already weak vertebra. In the study of prophylactic vertebroplasty, it can be cautiously suggested that if the vertebra is osteoporotic and adjacent level is located at pivot of spinal column, the prophylactic augmentation may be an option to avoid anterior body shift effect and prevent the adjacent vertebral failure. In the study of bone cement leakage, we suggest that the integrity of vertebral structure should be examined before the operation of vertebroplasty. If surgeon could avoid bone cement infiltrating to the cortical defect and basivertebral vein, the risk of cement leakage could be minimized. In the study of augmented vertebral refracture, we found the failure mechanism of augmented vertebrae is the presence of fracture lines, which are induced by the uneven strain distribution within the vertebrae. Technique or strategy equalizing the strain distribution within the vertebrae and spinal column seems to be important in preventing the post surgery fracture.
In this study, the biomechanical mechanism of vertebroplasty complications were systematically investigated using porcine and human cadaveric vertebrae. The strategies for complication reduction are suggested to increase the long term surgery efficacy on compression fracture recovery.
Subjects
Vertebroplasty
Biomechanics
Adjacent Vertebral Failure
Cement Leakage
Vertebral Refracture
Type
thesis
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