Biomechanical comparison of kyphoplasty versus a titanium mesh implant with cement for stabilization of vertebral compression fractures

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2010-09, Vol.35 (19), p.1783-1788
• Main Authors: Upasani, Vidyadhar V, Robertson, Claire, Lee, Deborah, Tomlinson, Tucker, Mahar, Andrew T
• Format: Article
• Language: English
• Subjects: Aged; Biomechanical Phenomena; Bone Cements; Cadaver; Equipment Design; Fracture Fixation - instrumentation; Fractures, Compression - diagnostic imaging; Fractures, Compression - physiopathology; Fractures, Compression - surgery; Humans; Joint Instability - diagnostic imaging; Joint Instability - physiopathology; Joint Instability - surgery; Kyphoplasty; Lumbar Vertebrae - diagnostic imaging; Lumbar Vertebrae - injuries; Lumbar Vertebrae - physiopathology; Lumbar Vertebrae - surgery; Male; Middle Aged; Orthopedic Fixation Devices; Polymethyl Methacrylate; Spinal Fractures - diagnostic imaging; Spinal Fractures - physiopathology; Spinal Fractures - surgery; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - injuries; Thoracic Vertebrae - physiopathology; Thoracic Vertebrae - surgery; Titanium; Tomography, X-Ray Computed; Weight-Bearing
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/BRS.0b013e3181b7cc5d

In vitro biomechanical investigation. To evaluate differences in biomechanical stability of vertebral compression fractures repaired using balloon kyphoplasty versus a titanium mesh implant. Vertebral compression fractures may be stabilized using an expandable balloon followed by cement injection. There are small but finite risks of endplate fracture and cement extravasation with this procedure. Alternative techniques may affect cement injection volumes, height maintenance, and biomechanical stability but require investigation. Four male human cadaveric spines from T2 to L5 were used in this study. After determining bone mineral density, individual vertebral bodies were dissected and inspected for previous fractures or additional exclusion criteria. In the remaining vertebral bodies (n=48) anterior wedge fractures were created using a materials testing machine. Fractured vertebral bodies were systematically randomized to be repaired either with balloon kyphoplasty or with titanium mesh implant and polymethylmethacrylate bone cement, using image intensified fluoroscopy. Anterior vertebral body height (cm) was measured initially, after mechanically creating an anterior wedge fracture, after repairing the compression fracture with either technique, and after recompressing the vertebral body following a 24-hour cement polymerization period. Data for cement injection volume (mL) and height maintained following testing (cm) were compared between repair groups using a 1-way analysis of variance (P