title: Vertebral augmentation with a novel Vessel-X bone void filling container system and bioactive bone cement.
abstract: METHODS
  Evaluation of a novel, leakage-free vertebroplastic instrumentation by fresh cadaveric studies.
  
  
  OBJECTIVE
  To compare Vessel-X, a novel percutaneous bone void filling container system, with conventional kyphoplasty in restoring strength, stiffness, and height in experimentally induced vertebral compressive fractures and morphologically determine the cement distribution.
  
  
  BACKGROUND
  Clinically, both vertebroplasty and kyphoplasty perform well in reinforcement and pain relief. One of the shortcomings, however, is the risk of cement leakage. Vessel-X is a novel bone expander and bone void filler combined instrumentation for vertebral augmentation requiring evaluation.
  
  
  METHODS
  A total of 28 fresh-frozen vertebral specimens were randomly assigned to 4 groups for testing: unipedicular kyphoplasty, bipedicular kyphoplasty, unipedicular Vessel-X, and bipedicular Vessel-X. Compressive fractures were experimentally created on each vertebra after determining the bone mineral density. Kyphoplasty and Vessel-X were performed using bioactive bone cement (SrHAC) under C-arm fluoroscopy and compared by compression testing to measure the effects of augmentation. Morphologic observations were also performed to determine the cement distribution and vertebral height restoration.
  
  
  RESULTS
  There was no significant difference in bone mineral density, initial strength, and stiffness in any of the groups. Furthermore, no significant difference was observed in total cement volume in intragroup comparison within the unipedicular or bipedicular groups. Vessel-X bone filler container could expand well and contain most of the cement. The height restoration ranged from 88.5% to 96.4% in all groups. The augmented strength with unipedicular and bipedicular injections reached 3651.57 N and 4833.73 N, respectively. Stiffness with bipedicular injection was significantly higher than that of unipedicular injection.
  
  
  CONCLUSIONS
  Vessel-X was comparable to kyphoplasty in restoring the mechanical properties and height of the fractured vertebrae. Interestingly, Vessel-X instrumentation showed considerably less cement leakage and better cement placement in the vertebral body. Therefore, it could be a leakage controllable technique in percutaneous vertebral augmentation.
authors.affiliation: Department of Orthopaedics and Traumatology, University of Hong Kong, Hong Kong, China.
authors.forename: Zhaomin
authors.initials: Z
authors.lastname: Zheng
authors.forename: Keith D K
authors.initials: KD
authors.lastname: Luk
authors.forename: Guanming
authors.initials: G
authors.lastname: Kuang
authors.forename: Zhaoyang
authors.initials: Z
authors.lastname: Li
authors.forename: Jerry
authors.initials: J
authors.lastname: Lin
authors.forename: Wing M
authors.initials: WM
authors.lastname: Lam
authors.forename: Kenneth M C
authors.initials: KM
authors.lastname: Cheung
authors.forename: William W
authors.initials: WW
authors.lastname: Lu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D015519:Bone Density; D002102:Cadaver; D019245:Compressive Strength; D017886:Durapatite / Q000627:therapeutic use*; D004867:Equipment Design; D005260:Female; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011475:Prosthesis Failure; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D013314:Stress, Mechanical; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D001843:Bone Cements; C509320:strontium-containing hydroxyapatite; D017886:Durapatite