title: Cementless Titanium Mesh Fixation of Osteoporotic Burst Fractures of the Lumbar Spine Leads to Bony Healing: Results of an Experimental Sheep Model.
abstract: BACKGROUND
  Current treatment strategies for osteoporotic vertebral compression fractures (VCFs) focus on cement-associated solutions. Complications associated with cement application are leakage, embolism, adjacent fractures, and compromise in bony healing. This study comprises a validated VCF model in osteoporotic sheep in order to (1) evaluate a new cementless fracture fixation technique using titanium mesh implants (TMIs) and (2) demonstrate the healing capabilities in osteoporotic VCFs.
  
  
  METHODS
  Twelve 5-year-old Merino sheep received ovariectomy, corticosteroid injections, and a calcium/phosphorus/vitamin D-deficient diet for osteoporosis induction. Standardized VCFs (type AO A3.1) were created, reduced, and fixed using intravertebral TMIs. Randomly additional autologous spongiosa grafting (G1) or no augmentation was performed (G2, n = 6 each). Two months postoperatively, macroscopic, micro-CT and biomechanical evaluation assessed bony consolidation.
  
  
  RESULTS
  Fracture reduction succeeded in all cases without intraoperative complications. Bony consolidation was proven for all cases with increased amounts of callus development for G2 (58.3%). Micro-CT revealed cage integration. Neither group showed improved results with biomechanical testing.
  
  
  CONCLUSIONS
  Fracture reduction/fixation using TMIs without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing. Intravertebral application of autologous spongiosa showed no beneficial effects. The technique is now available for clinical use; thus, it offers an opportunity to abandon cement-associated complications.
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Anica
authors.identifier: 0000-0002-3189-0849
authors.initials: A
authors.lastname: Eschler
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Paula
authors.initials: P
authors.lastname: Roepenack
authors.affiliation: Clinic for Anesthesiology and Critical Care Medicine, University of Rostock, Medical Center, Schillingallee 35, 18059 Rostock, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Roesner
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Philipp Karl Ewald
authors.initials: PK
authors.lastname: Herlyn
authors.affiliation: Institute for Biomedical Engineering, University of Rostock, F. Barnewitz-Straße 4, 18119 Rostock, Germany.
authors.forename: Heiner
authors.initials: H
authors.lastname: Martin
authors.affiliation: Faculty of Mechanical Engineering and Marine Technology, Chair of Mechanical Engineering Design/Lightweight Design, University of Rostock, Albert-Einstein-Straße 2, 18059 Rostock, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Reichel
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Rotter
authors.affiliation: Rudolf-Zenker Institute for Experimental Surgery, University of Rostock, Medical Center, Schillingallee 69a, 18057 Rostock, Germany.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Vollmar
authors.affiliation: Department of Trauma, Hand and Reconstructive Surgery, University of Rostock, Medical Center, Schillingallee 35, 18057 Rostock, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mittlmeier
authors.affiliation: Department of Trauma, Orthopedic and Reconstructive Surgery, Munich Municipal Hospital Group, Clinic Harlaching, Sanatoriumsplatz 2, 81545 Munich, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Gradl
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D017102:Fracture Healing; D016268:Internal Fixators; D008159:Lumbar Vertebrae / Q000601:surgery*; D012756:Sheep; D016103:Spinal Fractures / Q000601:surgery*; D013526:Surgical Mesh; D014025:Titanium
chemical_list: D014025:Titanium