Biomechanical comparison of augmentation techniques for insufficiency fractures.
METHODS
Biomechanical laboratory research.


OBJECTIVE
To compare 4 techniques for vertebral body insufficiency fracture repair by analyzing restoration of height, strength, and stiffness, and quantifying cement leakage.


BACKGROUND
Current techniques for insufficiency fracture repair, restore prefracture strength, and all potentially have the complication of cement extrusion. To our knowledge, there is no information directly comparing different augmentation techniques.


METHODS
There were 4 osteoporotic/osteopenic fresh cadaveric spines' (T6-L5) vertebral bodies divided into the 4 groups and by levels (thoracic, thoracolumbar, lumbar). They were compressed to 25% of their initial height to simulate insufficiency fractures. Fixation techniques were vertebroplasty, osteoplasty (Interpore Cross Int., Irvine, CA), the Cavity Creation System (Synthes, Paoli, PA), and kyphoplasty (Kyphon, Sunnyvale, CA). Fractures were fixed using 3 cc of bone cement and recompressed.


RESULTS
No significant difference was found in strength, height restoration, or stiffness among techniques (P < 0.05). Stiffness was significantly different in the lumbar levels between initial and post-fixation measurements (P < 0.05). Cement extrusion of 1 mL was seen in 1 vertebroplasty specimen.


CONCLUSIONS
The 4 techniques equally restored strength and stiffness. No difference was seen in height restoration. Cement extrusion was significant in only 1 vertebral body, which may be attributable to the cement quantity.
McCann
Heather
H
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA. mccann@musc.edu
LePine
Matthew
M
Glaser
John
J
D001843:Bone Cements / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000150:complications; D019245:Compressive Strength / Q000502:physiology; D050815:Fractures, Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D066298:In Vitro Techniques; D008159:Lumbar Vertebrae / Q000293:injuries / Q000502:physiology* / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010024:Osteoporosis / Q000150:complications; D016103:Spinal Fractures / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries / Q000502:physiology* / Q000601:surgery
D001843:Bone Cements