title: Does bone cement in percutaneous vertebroplasty act as a stress riser?
abstract: METHODS
  An in vitro cadaveric study.
  
  
  OBJECTIVE
  To determine whether percutaneous vertebroplasty (PVP) with a clinically relevant amount of bone cement is capable of causing stress peaks in adjacent-level vertebrae.
  
  
  BACKGROUND
  It is often suggested that PVP of a primary spinal fracture causes stress peaks in adjacent vertebrae, thereby leading to additional fractures. The in vitro studies that demonstrated this relationship, however, use bigger volumes of bone cement used clinically.
  
  
  METHODS
  Ten fresh-frozen vertebrae were loaded until failure, while registering force and displacement as well as the pressure under the lower endplate. After failure, the vertebrae were augmented with clinically relevant amounts of bone cement and then again loaded until failure. The force, displacement, and pressure under the lower endplate were again registered.
  
  
  RESULTS
  Stress peaks were not related to the location of the injected bone cement. Both failure load and stiffness were significantly lower after augmentation.
  
  
  CONCLUSIONS
  On the basis of our findings, we conclude that vertebral augmentation with clinically relevant amounts of bone cement does not lead to stress peaks under the endplate. It is therefore unlikely that PVP, in itself, causes detrimental stresses in the adjacent vertebrae, leading to new vertebral fractures.
  
  
  METHODS
  N/A.
authors.affiliation: *Radboud University Nijmegen Medical Centre, Orthopaedic Research Laboratory, Nijmegen, the Netherlands; and †Twente University, Laboratory for Biomechanical Engineering, Enschede, the Netherlands.
authors.forename: René
authors.initials: R
authors.lastname: Aquarius
authors.forename: Astrid Maria
authors.initials: AM
authors.lastname: van der Zijden
authors.forename: Jasper
authors.initials: J
authors.lastname: Homminga
authors.forename: Nico
authors.initials: N
authors.lastname: Verdonschot
authors.forename: Esther
authors.initials: E
authors.lastname: Tanck
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001843:Bone Cements; D002102:Cadaver; D005260:Female; D050815:Fractures, Compression / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D016103:Spinal Fractures / Q000503:physiopathology / Q000601:surgery*; D013131:Spine / Q000503:physiopathology / Q000601:surgery; D013314:Stress, Mechanical; D054854:Vertebroplasty / Q000379:methods*; D016474:Weight-Bearing
chemical_list: D001843:Bone Cements