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Vertebroplasty for vertebral fragility fractures in the 'very elderly': experience from a regional UK spine unit

Sahota A, Ong T, Kumar A, Simmonds L, Yoon WW, Salem K, et al.

Osteoporos Int, 2021 02;32(2):395-396.
PMID: 33392717 DOI: 10.1007/s00198-020-05770-w
Matched MeSH terms: Vertebroplasty*
Fulltext Images of the month: Pulmonary cement embolism

Chai CS, Kho SS, Chan SK, Tee TT, Tie ST

Clin Med (Lond), 2021 Jan;21(1):e114-e115.
PMID: 33479093 DOI: 10.7861/clinmed.2020-0913

Percutaneous vertebroplasty (PV) involves injection of polymethylmethacrylate bone cement into vertebral body for relief of pain and strengthening of bone in symptomatic vertebral compression fractures.Passage of bone cement into vertebral venous plexus and then into the lungs is a rare and serious complication of PV. The reported incidence up to 26%.We present an incidental finding of pulmonary cement embolism (PCE) after PV. A 68-year-old woman with history of PV 3 years previously for T11 osteoporotic fracture presented to us with cough for 3 weeks following choking on a fish bone.Chest X-ray showed left lower zone consolidation and a high-density opacity in a tubular branching pattern, corresponding to pulmonary arterial distribution. Contrasted computed tomography of the thorax showed segmental pulmonary cement embolism of both lungs and left lower lobe consolidation.She underwent bronchoscopy with findings of a purulent secretion from the left lower lobe. Her symptoms resolved after 2 weeks of antibiotics. She was managed conservatively for the PCE as she remained asymptomatic.This case highlights the need for a standard post-PV chest X-ray, as patients with cement embolisms can be completely asymptomatic. Measures to minimise the risk of pulmonary cement embolisms during PV need to be taken.

Matched MeSH terms: Vertebroplasty*
Synthesis and characterization of a new vertebroplasty cement based on gold-containing PMMA microspheres

Jacobs E, Saralidze K, Roth AK, de Jong JJ, van den Bergh JP, Lataster A, et al.

Biomaterials, 2016 Mar;82:60-70.
PMID: 26751820 DOI: 10.1016/j.biomaterials.2015.12.024

There are a number of drawbacks to incorporating large concentrations of barium sulfate (BaSO4) as the radiopacifier in PMMA-based bone cements for percutaneous vertebroplasty. These include adverse effects on injectability, viscosity profile, setting time, mechanical properties of the cement and bone resorption. We have synthesized a novel cement that is designed to address some of these drawbacks. Its powder includes PMMA microspheres in which gold particles are embedded and its monomer is the same as that used in commercial cements for vertebroplasty. In comparison to one such commercial cement brand, VertaPlex™, the new cement has longer doughing time, longer injection time, higher compressive strength, higher compressive modulus, and is superior in terms of cytotoxicity. For augmentation of fractured fresh-frozen cadaveric vertebral bodies (T6-L5) using simulated vertebroplasty, results for compressive strength and compressive stiffness of the construct and the percentage of the volume of the vertebral body filled by the cement were comparable for the two cements although the radiopacity of the new cement was significantly lower than that for VertaPlex™. The present results indicate that the new cement warrants further study.

Matched MeSH terms: Vertebroplasty/methods*
Fulltext Effect of Polymethylmethacrylate-Hydroxyapatite Composites on Callus Formation and Compressive Strength in Goat Vertebral Body

Komang-Agung IS, Hydravianto L, Sindrawati O, William PS

Malays Orthop J, 2018 Nov;12(3):6-13.
PMID: 30555640 DOI: 10.5704/MOJ.1811.002

Introduction: Percutaneous vertebroplasty (PV) is one of the available treatments for vertebral compression fracture (VCF). Polymethylmethacrylate (PMMA) is the most common bone substitute used in the procedure, but it has several disadvantages. Bioceramic material, such as hydroxyapatite (HA), has better biological activity compared to PMMA. The aim of this study was to find an optimal biomaterial compound which offers the best mechanical and biological properties to be used in PV. Materials and Methods: This was an experimental study with goat (Capra aegagrus hircus) as an animal model. The animals' vertebral columns were injected with PMMA-HA compound. Animal samples were divided into four groups, and each group received a different proportion of PMMA:HA compound. The mechanical and biological effects of the compound on the bone were then analysed. The mechanical effect was assessed by measuring the vertebral body's compressive strength. Meanwhile, the biological effect was assessed by analysing the callus formation in the vertebral body. Results: The optimal callus formation and compressive strength was observed in the group receiving PMMA:HA with a 1:2 ratio. Conclusion: A mixture of PMMA and HA increases the quality of callus formation and the material's compressive strength. The optimum ratio of PMMA:HA in the compound is 1:2.

Matched MeSH terms: Vertebroplasty
Fulltext Cement vertebroplasty in the elderly with osteoporotic vertebral fractures. a preliminary study on the change in activity of daily living after treatment

Looi, Collin Seng-Kim

International e-Journal of Science, Medicine & Education, 2009;3(2):-.
MyJurnal

Background: To assess the effect of cement vertebroplasty on the activity of daily living of elderly patients who have sustained a vertebral osteoporotic fracture.
Patients and Methods: Seven patients with clinically significant and radiologically proven osteoporotic vertebral compression fractures suitable to be treated with percutaneous cement vertebroplasty were recruited. Evaluation was based on pre- and postprocedure activity by clinical documentation (including interview) and by a self-developed questionnaire (including quality of life).
Results: Following the procedure, 54% of patients resumed their activities of daily living with minimal pain while 46% of patients were able to do so without any pain (p

Matched MeSH terms: Vertebroplasty
Do the dynamic stress mobility radiographs predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty for osteoporotic thoracolumbar vertebral fractures with intravertebral cleft?

Chiu CK, Lisitha KA, Elias DM, Yong VW, Chan CYW, Kwan MK

J Orthop Surg (Hong Kong), 2018 10 26;26(3):2309499018806700.
PMID: 30352524 DOI: 10.1177/2309499018806700

BACKGROUND: This prospective clinical-radiological study was conducted to determine whether the dynamic mobility stress radiographs can predict the postoperative vertebral height restoration, kyphosis correction, and cement volume injected after vertebroplasty.
METHODS: Patients included had the diagnosis of significant back pain caused by osteoporotic vertebral compression fracture secondary to trivial injury. All the patients underwent routine preoperative sitting lateral spine radiograph, supine stress lateral spine radiograph, and supine anteroposterior spine radiograph. The radiological parameters recorded were anterior vertebral height (AVH), middle vertebral height (MVH), posterior vertebral height (PVH), MVH level below, wedge endplate angle (WEPA), and regional kyphotic angle (RKA). The supine stress versus sitting difference (SSD) for all the above parameters were calculated.
RESULTS: A total of 28 patients (4 males; 24 females) with the mean age of 75.6 ± 7.7 years were recruited into this study. The mean cement volume injected was 5.5 ± 1.8 ml. There was no difference between supine stress and postoperative radiographs for AVH ( p = 0.507), PVH ( p = 0.913) and WEPA ( p = 0.379). The MVH ( p = 0.026) and RKA ( p = 0.005) were significantly less in the supine stress radiographs compared to postoperative radiographs. There was significant correlation ( p < 0.05) between supine stress and postoperative AVH, MVH, PVH, WEPA, and RKA. The SSD for AVH, PVH, WEPA, and RKA did not have significant correlation with the cement volume ( p > 0.05). Only the SSD-MVH had significant correlation with cement volume, but the correlation was weak ( r = 0.39, p = 0.04).
CONCLUSIONS: Dynamic mobility stress radiographs can predict the postoperative vertebral height restoration and kyphosis correction after vertebroplasty for thoracolumbar osteoporotic fracture with intravertebral clefts. However, it did not reliably predict the amount of cement volume injected as it was affected by other factors.

Matched MeSH terms: Vertebroplasty/methods*