Publisher DOI: 10.1007/s00586-013-2809-2
Title: Does the cement stiffness affect fatigue fracture strength of vertebrae after cement augmentation in osteoporotic patients?
Language: English
Authors: Kolb, Jan Philipp 
Kueny, Rebecca A. 
Püschel, Klaus 
Boger, Andreas 
Rueger, Johannes M. 
Morlock, Michael 
Huber, Gerd 
Lehmann, Wolfgang 
Keywords: Adjacent-level fracture; Bone cement; Cement stiffness; Osteoporosis; Vertebroplasty
Issue Date: 16-May-2013
Publisher: Springer
Source: European Spine Journal 7 (22): 1650-1656 (2013)
Abstract (english): 
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. © 2013 Springer-Verlag Berlin Heidelberg.
ISSN: 0940-6719
Journal: European spine journal 
Institute: Biomechanik M-3 
Document Type: Article
Project: SPINEFX: A University–Industry Network for the Training of High-quality Multidisciplinary Researchers to Deliver Enterprising, Cost-effective Surgical Solutions for Spinal Disease and Trauma 
More Funding information: Marie Curie ITN
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