Venous injection of a triphasic calcium-based implant in a sheep model of pulmonary embolism demonstrates minimal acute systemic effects

• Published in: European spine journal 2022-10, Vol.31 (10), p.2812-2821
• Main Authors: Constant, Caroline, Stroncek, John D., Zeiter, Stephan, Arens, Daniel, Nehrbass, Dirk, Gehweiler, Dominic, Menzel, Ursula, Benneker, Lorin M., Hill, Ronald S., Albers, Christoph E.
• Format: Article
• Language: English
• Subjects: Animal models; Blood flow; Blood pressure; Bone surgery; Calcium phosphates; Calcium sulfate; Carbon dioxide; Coagulation; Embolism; Femur; Heart rate; Histopathology; Injection; Leakage; Medicine; Medicine & Public Health; Necropsy; Neurosurgery; Original Article; Oxygenation; Polymethyl methacrylate; Polymethylmethacrylate; Pulmonary embolisms; Serum levels; Sheep; Surgical Orthopedics; Tricalcium phosphate; Vertebrae
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-022-07303-x

Purpose Implant leakage is the most common complication of vertebral augmentation. Alternative injectable materials must demonstrate intravascular safety comparable to or better than polymethyl methacrylate (PMMA). This study assessed the systemic effects of a triphasic calcium-based implant or PMMA injected directly into the femoral vein in a large animal model designed to mimic severe intravascular implant leakage. Methods Six skeletally mature female sheep were randomly assigned ( n  = 3) to either the PMMA or the triphasic implant (AGN1, composition: calcium sulfate, β -tricalcium phosphate, brushite) treatment group. Femoral veins of each sheep were directly injected with 0.5 mL of implant material to mimic leakage volumes reported during PMMA vertebroplasty. To compare acute systemic effects of the materials, cardiovascular parameters, laboratory coagulation markers, and calcium and sulfate serum levels were monitored for 60 min after implant injection. Thrombotic and embolic events were evaluated by radiologic imaging, necropsy, and histopathology. Results Heart rate, systemic arterial blood pressure, arterial oxygenation, arterial carbon dioxide content, and coagulation markers remained within physiological range after either AGN1 or PMMA injection. No blood flow interruption in the larger pulmonary vessels was observed in either group. Lung histopathology revealed that the severity of thrombotic changes after AGN1 injection was minimal to slight, while changes after PMMA injection were minimal to massive. Conclusion Acute systemic effects of intravascular AGN1 appeared to be comparable to or less than that of intravascular PMMA. Furthermore, in this preliminary study, the severity and incidence of pulmonary histological changes were lower for AGN1 compared to PMMA.