title: Minimum cement volume for vertebroplasty.
abstract: OBJECTIVE
  Percutaneous vertebroplasty is a widely used vertebral augmentation technique. It is a minimally invasive and low-risk procedure, but has some disadvantages with a relatively high number of bone cement leaks and adjacent vertebral fractures. The aim of this cadaveric study was to determine the minimum percentage of cement fill volume in vertebroplasty needed to restore vertebral stiffness and adjacent intradiscal pressure.
  
  
  METHODS
  Thirteen thoracolumbar spine mobile segments were loaded to induce a vertebral fracture. After fracture vertebroplasty was performed, four times in the same fractured vertebra. The injected cement volume was 5 % of the fractured vertebral volume to reach 5, 10, 15 and 20 % of cement fill. Biomechanical testing was performed before the fracture, after the fracture and after each cement injection.
  
  
  RESULTS
  After vertebral fracture compressive stiffness was reduced to 47 % of the pre-fracture value and was partially restored to 61 % after 10 % cement fill. With vertebroplasty intradiscal pressure gradually increased, depending on specimen position, from 48 to a total of 71 % at 15 % of cement fill.
  
  
  CONCLUSIONS
  Compressive stiffness and intradiscal pressure increase with the percentage of cement fill. Fifteen per cent of cement fill was the limit beyond which no substantial increase in compressive stiffness or intradiscal pressure could be detected and is the minimum volume of cement we recommend for vertebroplasty. In the average thoracolumbar vertebra this means 4-6 ml of cement.
authors.affiliation: Department of Orthopaedic Surgery, University Medical Centre Ljubljana, Zaloška cesta 9, 1000, Ljubljana, Slovenia.
authors.forename: David
authors.initials: D
authors.lastname: Martinčič
authors.forename: Miha
authors.initials: M
authors.lastname: Brojan
authors.forename: Franc
authors.initials: F
authors.lastname: Kosel
authors.forename: Darko
authors.initials: D
authors.lastname: Štern
authors.forename: Tomaž
authors.initials: T
authors.lastname: Vrtovec
authors.forename: Vane
authors.initials: V
authors.lastname: Antolič
authors.forename: Rok
authors.initials: R
authors.lastname: Vengust
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001696:Biomechanical Phenomena; D001843:Bone Cements / Q000627:therapeutic use*; D002102:Cadaver; D002484:Cementation; D005260:Female; D006801:Humans; D007267:Injections; D008159:Lumbar Vertebrae / Q000503:physiopathology / Q000601:surgery; D008297:Male; D016103:Spinal Fractures / Q000503:physiopathology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000503:physiopathology / Q000601:surgery*; D054854:Vertebroplasty / Q000379:methods*
chemical_list: D001843:Bone Cements