Balloon vertebroplasty with calcium phosphate cement augmentation for direct restoration of traumatic thoracolumbar vertebral fractures.
METHODS
A human cadaveric model was used to evaluate balloon vertebroplasty in traumatic vertebral fractures.


OBJECTIVE
To assess the feasibility and safety of balloon vertebroplasty followed by calcium phosphate cement augmentation to prevent recurrent kyphosis.


BACKGROUND
Failure after short-segment pedicle-screw fixation for the treatment of vertebral fractures is probably caused by a redistribution of disc material through the fractured endplate into the vertebral body, causing a decrease in anterior column support. This lack of support can give rise to instrument breakage and recurrent kyphosis after removal of the instrumentation. Restoration of the endplate morphology could prevent these events.


METHODS
Twenty-three traumatic fractures of thoracolumbar vertebrae were created. All fractures were distracted and fixated with short-segment pedicle screws and rods. Transpedicularly introduced inflatable bone tamps and subsequent injection of calcium phosphate cement were used to restore the endplates. Quantitative analyses of magnetic resonance images obtained at three time points were used to evaluate the morphology of the vertebral body and disc-space. After slicing all specimens, macroscopical examination was performed to detect leakage of cement or bone displacement in undesired directions.


RESULTS
No technical problems were encountered during the study. The balloon vertebroplasty resulted in a significant (P = 0.0014) decrease of cranial endplate impression. No cement leakage or undesired bone displacement could be detected radiologically or macroscopically.


CONCLUSIONS
The present study suggests that balloon vertebroplasty may be a safe and feasible procedure for the restoration of traumatic thoracolumbar vertebral fractures.
Verlaan
J J
JJ
Department or Orthopaedics, University Medical Center, Utrecht, The Netherlands. j.j.verlaan@chir.azu.nl
van Helden
W H
WH
Oner
F C
FC
Verbout
A J
AJ
Dhert
W J A
WJ
D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects; D001843:Bone Cements / Q000009:adverse effects / Q000627:therapeutic use; D002102:Cadaver; D002130:Calcium Phosphates / Q000008:administration & dosage* / Q000009:adverse effects; D005240:Feasibility Studies; D005260:Female; D005471:Fluoroscopy; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007267:Injections; D016268:Internal Fixators; D007738:Kyphosis / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000293:injuries / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D019736:Prostheses and Implants / Q000009:adverse effects; D016103:Spinal Fractures / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D013904:Thoracic Vertebrae / Q000187:drug effects / Q000293:injuries / Q000601:surgery
D001672:Biocompatible Materials; D001843:Bone Cements; D002130:Calcium Phosphates; C485828:alpha-tricalcium phosphate; C485830:tetracalcium phosphate; C485838:calcium phosphate, monobasic, anhydrous; C020243:calcium phosphate; C485829:calcium phosphate, dibasic, anhydrous