title: Minimum cement volume required in vertebral body augmentation--A biomechanical study comparing the permanent SpineJack device and balloon kyphoplasty in traumatic fracture.
abstract: BACKGROUND
  Minimally invasive treatment of vertebral fractures is basically characterized by cement augmentation. Using the combination of a permanent implant plus cement, it is now conceivable that the amount of cement can be reduced and so this augmentation could be an attractive opportunity for use in traumatic fractures in young and middle-aged patients. The objective of this study was to determine the smallest volume of cement necessary to stabilize fractured vertebrae comparing the SpineJack system to the gold standard, balloon kyphoplasty.
  
  
  METHODS
  36 fresh frozen human cadaveric vertebral bodies (T11-L3) were utilized. After creating typical compression wedge fractures (AO A1.2.1), the vertebral bodies were reduced by SpineJack (n=18) or kyphoplasty (n=18) under preload (100N). Subsequently, different amounts of bone cement (10%, 16% or 30% of the vertebral body volume) were inserted. Finally, static and dynamic biomechanical tests were performed.
  
  
  RESULTS
  Following augmentation and fatigue tests, vertebrae treated with SpineJack did not show any significant loss of intraoperative height gain, in contrast to kyphoplasty. In the 10% and 16%-group the height restoration expressed as a percentage of the initial height was significantly increased with the SpineJack (>300%). Intraoperative SpineJack could preserve the maximum height gain (mean 1% height loss) better than kyphoplasty (mean 16% height loss).
  
  
  CONCLUSIONS
  In traumatic wedge fractures it is possible to reduce the amount of cement to 10% of the vertebral body volume when SpineJack is used without compromising the reposition height after reduction, in contrast to kyphoplasty that needs a 30% cement volume.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Germany. Electronic address: robert.rotter@med.uni-rostock.de.
authors.forename: Robert
authors.initials: R
authors.lastname: Rotter
authors.affiliation: Institute for Biomedical Engineering, University of Rostock, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Schmitt
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Gierer
authors.affiliation: Institute for Biomedical Engineering, University of Rostock, Germany.
authors.forename: Klaus-Peter
authors.initials: KP
authors.lastname: Schmitz
authors.affiliation: Spine-Unit, University Hospital Valladolid, Royal Academy of Medicine and Surgery, Spain.
authors.forename: David
authors.initials: D
authors.lastname: Noriega
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittlmeier
authors.affiliation: University of Heidelberg, Germany.
authors.forename: Peter-J
authors.initials: PJ
authors.lastname: Meeder
authors.affiliation: Institute for Biomedical Engineering, University of Rostock, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Martin
mesh_terms: D000368:Aged; D001696:Biomechanical Phenomena; D001843:Bone Cements / Q000627:therapeutic use*; D002102:Cadaver; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019736:Prostheses and Implants; D019919:Prosthesis Implantation / Q000379:methods; D019651:Plastic Surgery Procedures / Q000379:methods; D016103:Spinal Fractures / Q000601:surgery*; D013131:Spine / Q000601:surgery
chemical_list: D001843:Bone Cements
keywords: Cement; Fracture; Kyphoplasty; Spine; SpineJack; Volume