title: Trabecular Microstructure and Damage Affect Cement Leakage From the Basivertebral Foramen During Vertebral Augmentation.
abstract: METHODS
  A prospective study on cadaver specimens.
  
  
  OBJECTIVE
  To explore why cement leakage from basivertebral foramen (BF) easily occurs during vertebral augmentation procedures.
  
  
  BACKGROUND
  Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown.
  
  
  METHODS
  In this study, 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of intertrabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation, and imaging-based diagnosis were used to evaluate cement leakage.
  
  
  RESULTS
  Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P < 0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that intertrabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously in Wang et al. (Spine J 2014;14: 1551-1558).
  
  
  CONCLUSIONS
  The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest intervertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
authors.forename: Shengyun
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.|Department of Orthopedic surgery, Singapore General Hospital, Singapore.
authors.forename: Chongyan
authors.initials: C
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Shan
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
authors.forename: Junhui
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
authors.forename: Tianming
authors.initials: T
authors.lastname: Yu
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
authors.forename: Xuyang
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
authors.forename: Shunwu
authors.initials: S
authors.lastname: Fan
authors.affiliation: Department of Orthopedic Surgery, University of California-Davis Medical Center; Sacramento, CA.
authors.forename: Blaine A
authors.initials: BA
authors.lastname: Christiansen
authors.affiliation: Department of Spine Surgery, Third Hospital of HeBei Medical University, Shijiazhuang, People' Republic of China.
authors.forename: Wenyuan
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of Orthopedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, People' Republic of China.
authors.forename: Fengdong
authors.initials: F
authors.lastname: Zhao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements / Q000627:therapeutic use*; D002102:Cadaver; D000071556:Cancellous Bone / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D050815:Fractures, Compression / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019279:Resin Cements; D016103:Spinal Fractures / Q000601:surgery*
chemical_list: D001843:Bone Cements; D019279:Resin Cements