Vertebral body stenting: a new method for vertebral augmentation versus kyphoplasty.
Vertebroplasty and kyphoplasty are well-established minimally invasive treatment options for compression fractures of osteoporotic vertebral bodies. Possible procedural disadvantages, however, include incomplete fracture reduction or a significant loss of reduction after balloon tamp deflation, prior to cement injection. A new procedure called "vertebral body stenting" (VBS) was tested in vitro and compared to kyphoplasty. VBS uses a specially designed catheter-mounted stent which can be implanted and expanded inside the vertebral body. As much as 24 fresh frozen human cadaveric vertebral bodies (T11-L5) were utilized. After creating typical compression fractures, the vertebral bodies were reduced by kyphoplasty (n = 12) or by VBS (n = 12) and then stabilized with PMMA bone cement. Each step of the procedure was performed under fluoroscopic control and analysed quantitatively. Finally, static and dynamic biomechanical tests were performed. A complete initial reduction of the fractured vertebral body height was achieved by both systems. There was a significant loss of reduction after balloon deflation in kyphoplasty compared to VBS, and a significant total height gain by VBS (mean +/- SD in %, p < 0.05, demonstrated by: anterior height loss after deflation in relation to preoperative height [kyphoplasty: 11.7 +/- 6.2; VBS: 3.7 +/- 3.8], and total anterior height gain [kyphoplasty: 8.0 +/- 9.4; VBS: 13.3 +/- 7.6]). Biomechanical tests showed no significant stiffness and failure load differences between systems. VBS is an innovative technique which allows for the possibly complete reduction of vertebral compression fractures and helps maintain the restored height by means of a stent. The height loss after balloon deflation is significantly decreased by using VBS compared to kyphoplasty, thus offering a new promising option for vertebral augmentation.
Rotter
Robert
R
Department of Trauma and Reconstructive Surgery, University of Rostock, 18055, Rostock, Germany. robertrotter@yahoo.de
Martin
Heiner
H
Fuerderer
Sebastian
S
Gabl
Michael
M
Roeder
Christoph
C
Heini
Paul
P
Mittlmeier
Thomas
T
D000368:Aged; D002102:Cadaver; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications* / Q000601:surgery; D017063:Outcome Assessment, Health Care / Q000379:methods; D019919:Prosthesis Implantation / Q000379:methods; D011859:Radiography; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D015607:Stents / Q000009:adverse effects / Q000592:standards*; D016896:Treatment Outcome