Vertebroplasty increases compression of adjacent IVDs and vertebrae in osteoporotic spines |
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| Authors: | Srinidhi Nagaraja Hassan K. Awada Maureen L. Dreher Shikha Gupta Scott W. Miller |
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| Affiliation: | 1. MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton SO16 6YD, UK;2. NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK;3. Dept. of Internal Medicine, VieCuri Medical Center, Venloseweg 595971 PB Venlo, The Netherlands;4. Paediatric Endocrinology, Southampton University Hospitals NHS Foundation Trust, Southampton SO16 6YD, UK;5. Maastricht University Medical Center, Maastricht, The Netherlands;6. Department of Internal Medicine, Subdivision of Rheumatology, Maastricht University Medical Centre, Maastricht, The Netherlands;7. University Hasselt, Hasselt, Belgium;8. Department of Clinical Pharmacy & Toxicology, Maastricht University Medical Centre, Maastricht, The Netherlands;9. Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, 1.003 Vaughan House, Portsmouth, Road, M13 9PL, UK;10. Department of Pharmacoepidemiology & Clinical Pharmacology, University of Utrecht, Utrecht, The Netherlands, 3508, TB;11. NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Nuffield Orthopedic Centre, Headington, Oxford OX3 7HE, UK;1. Orthopedics Department, The First Afiliated Hospital of Heibei North University, Zhangjiakou 075000, China;2. Spine Surgery, Second Hopsital of Zhangjiakou City, Zhangjiakou 075000, China;3. Faculty of Graduate Studies, HeBei North University, Zhangjiakou 075000, China |
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| Abstract: | ![]()
Background contextApproximately 25% of vertebroplasty patients experience subsequent fractures within 1 year of treatment, and vertebrae adjacent to the cemented level are up to three times more likely to fracture than those further away. The increased risk of adjacent fractures postaugmentation raises concerns that treatment of osteoporotic compression fractures with vertebroplasty may negatively impact spine biomechanics.PurposeTo quantify the biomechanical effects of vertebroplasty on adjacent intervertebral discs (IVDs) and vertebral bodies (VBs).Study designA biomechanics study was conducted using cadaveric thoracolumbar spinal columns from elderly women (age range, 51–98 years).MethodsFive level motion segments (T11–L3) were assigned to a vertebroplasty treated or untreated control group (n=10/group) such that bone mineral density (BMD), trabecular architecture, and age were similar between groups. Compression fractures were created in the L1 vertebra of all specimens, and polymethylmethacrylate bone cement was injected into the fractured vertebra of vertebroplasty specimens. All spine segments underwent cyclic axial compression for 115,000 cycles. Microcomputed tomography imaging was performed before and after cyclic loading to quantify compression in adjacent VBs and IVDs.ResultsCyclic loading increased strains 3% on average in the vertebroplasty group when compared with controls after 115,000 cycles. This global strain manifested locally as approximately fourfold more compression in the superior VB (T12) and two- to fourfold higher axial and circumferential deformations in the superior IVD (T12–L1) of vertebroplasty-treated specimens when compared with untreated controls. Low BMD and high cement fill were significant factors that explained the increased strain in the vertebroplasty-treated group.ConclusionsThese data indicate that vertebroplasty alters spine biomechanics resulting in increased compression of adjacent VB and IVD in severely osteoporotic women and may be the basis for clinical reports of adjacent fractures after vertebroplasty. |
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| Keywords: | Vertebroplasty Osteoporosis Biomechanics Vertebral compression fracture Adjacent segment disease |
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