title: Stability of the metastatic spine pre and post vertebroplasty.
abstract: OBJECTIVE
  Vertebrae with lytic metastases have an elevated risk of burst fracture and resultant neurologic compromise. Prophylactic vertebroplasty has the potential to reduce pain and the risk of burst fracture in the metastatic spine. The purpose of this study was to quantify the ability of vertebroplasty to stabilize metastatically involved vertebrae against the risk of burst fracture initiation with a standardized model of vertebral metastases.
  
  
  METHODS
  Metastases were simulated in eight fresh-frozen cadaveric thoracolumbar spinal motion segments by removing a central core of trabecular bone and filling the defect with tumor tissue. Specimens were tested under a physiologic level of axial compression, intact, with a simulated tumor and post-vertebroplasty, and ultimately tested to failure. Axial load induced canal narrowing (CN) was used as a measure of the risk of burst fracture initiation. Following testing, vertebrae were axially sectioned to visualize cement fill.
  
  
  RESULTS
  Vertebrae with simulated metastases exhibited significantly higher CN than intact specimens (227%+/-109%; P<0.05). Post vertebroplasty, three vertebrae exhibited reduced CN compared with the simulated tumor configuration, whereas the other five had increased CN. Specimens with reduced CN were found to have cement posterior to the tumor, whereas specimens with an increase in CN had cement anterior and lateral to the tumor only. Percutaneous vertebroplasty is effective in decreasing CN if tumor is surrounded posteriorly with cement. However, injecting cement into the posterior third of the vertebral body is risky due to potential extravasation into the canal.
  
  
  CONCLUSIONS
  Future work aimed at improving cement fill is necessary for safe and consistent stabilization of the metastatic spine with vertebroplasty.
authors.affiliation: Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada.
authors.forename: Henry
authors.initials: H
authors.lastname: Ahn
authors.forename: Payam
authors.initials: P
authors.lastname: Mousavi
authors.forename: Sandie
authors.initials: S
authors.lastname: Roth
authors.forename: Declan
authors.initials: D
authors.lastname: Reidy
authors.forename: Joel
authors.initials: J
authors.lastname: Finkelstein
authors.forename: Cari
authors.initials: C
authors.lastname: Whyne
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D002102:Cadaver; D019245:Compressive Strength; D005260:Female; D005598:Fractures, Spontaneous / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D006801:Humans; D066298:In Vitro Techniques; D007593:Joint Instability / Q000209:etiology / Q000517:prevention & control*; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D016103:Spinal Fractures / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control*; D013125:Spinal Neoplasms / Q000150:complications / Q000503:physiopathology / Q000556:secondary* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements