title: An evaluation of fracture stabilization comparing kyphoplasty and titanium mesh repair techniques for vertebral compression fractures: is bone cement necessary?
abstract: METHODS
  In vitro biomechanical investigation using human cadaveric vertebral bodies.
  
  
  OBJECTIVE
  To evaluate differences in biomechanical stability of vertebral compression fractures (VCFs) repaired using an expandable titanium mesh implant, with and without cement, as compared with standard balloon kyphoplasty.
  
  
  BACKGROUND
  Vertebral augmentation, either in the form of vertebroplasty or kyphoplasty, is the treatment of choice for some VCFs. Polymethylmethacrylate, a common bone cement used in this procedure, has been shown to possibly cause injury to neural and vascular structures due to extravasation, embolization, and may be too rigid for an osteoporotic spine. Therefore, suitable alternatives for the treatment of VCFs have been sought.
  
  
  METHODS
  Individual vertebral bodies from 5 human cadaveric spines (from T4 to L5) were stripped of all soft tissues, and compressed at 25% of the intact height using methods previously described. Vertebral bodies were then randomly assigned to the following repair techniques: (1) conventional kyphoplasty, (2) titanium implant with cement, (3) titanium implant without cement. All vertebral bodies were then recompressed at 25% of the repaired height. Yield load, ultimate load, and stiffness were recorded and compared in these groups before and after treatment.
  
  
  RESULTS
  There were no differences in biomechanical data between intact groups, and between repaired groups. In all 3 treatment groups, yield load and ultimate load of repaired vertebrae were similar to that of intact vertebrae. However, the stiffness following repair was found to be statistically less than the stiffness of the intact vertebral body (P < 0.05 for all comparisons).
  
  
  CONCLUSIONS
  Based on the biomechanical data, the titanium mesh implant with or without cement was similar to polymethylmethacrylate fixation by kyphoplasty in the treatment of VCFs. Avoiding the adverse effects caused by using cement may be the main advantage of the titanium mesh implant and warrants further study.
authors.affiliation: Department of Orthopaedic Surgery, University of California, San Diego, CA, USA.
authors.forename: Hossein
authors.initials: H
authors.lastname: Ghofrani
authors.forename: Thomas
authors.initials: T
authors.lastname: Nunn
authors.forename: Claire
authors.initials: C
authors.lastname: Robertson
authors.forename: Andrew
authors.initials: A
authors.lastname: Mahar
authors.forename: Yupo
authors.initials: Y
authors.lastname: Lee
authors.forename: Steven
authors.initials: S
authors.lastname: Garfin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena / Q000502:physiology; D001843:Bone Cements / Q000009:adverse effects / Q000592:standards / Q000627:therapeutic use*; D002102:Cadaver; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D007593:Joint Instability / Q000503:physiopathology / Q000517:prevention & control / Q000601:surgery*; D058498:Kyphoplasty / Q000295:instrumentation* / Q000379:methods* / Q000592:standards; D008297:Male; D017063:Outcome Assessment, Health Care; D019904:Polymethyl Methacrylate / Q000009:adverse effects / Q000627:therapeutic use; D016103:Spinal Fractures / Q000601:surgery; D013526:Surgical Mesh / Q000592:standards*; D014025:Titanium / Q000627:therapeutic use*
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate; D014025:Titanium