Document Detail


A biomechanical analysis of intravertebral pressures during vertebroplasty of cadaveric spines with and without simulated metastases.
MedLine Citation:
PMID:  12865840     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY DESIGN: A biomechanical cadaveric study of thoracic and lumbar vertebrae with simulated metastases quantifying intravertebral pressures during transpedicular vertebroplasty. OBJECTIVE: To compare intravertebral pressures during percutaneous vertebroplasty in vertebrae with and without simulated lytic metastases. SUMMARY OF BACKGROUND DATA: Percutaneous vertebroplasty is designed to provide stability to vertebrae weakened by osteoporosis or metastatic disease. The complication rate is higher when the procedure is used for the treatment of lytic vertebral lesions. The major complications reported are radiculopathy, spinal cord compression, and embolic phenomena. METHODS: Ten fresh-frozen cadaveric vertebrae were tested intact (7 lumbar, 3 thoracic) and 7 were tested with simulated lytic defects (4 lumbar, 3 thoracic). Defects were created by replacing a core of cancellous bone with soft tumor tissue in the center of the vertebral body. Simplex P (Howmedica Osteonics, Mahwah, NJ) cement was injected into each vertebra through a unipedicular approach at a constant rate of 3 mL per minute. Cement volume, injection force, and intravertebral pressures at the posterior vertebral body wall were recorded. Following the procedure, the vertebrae were sectioned to visualize cement and tumor disbursement. RESULTS: There was no significant difference between the two groups for age, size, trabecular density, and cement volume. Vertebrae with simulated metastases generated an average maximum pressure of 39.66 kPa during cement injection versus 6.83 kPa in intact vertebrae (P < 0.05). Higher pressures were also generated in smaller vertebrae based on a power relationship (r2 = 0.71 intact, r2 = 0.43 tumor). CONCLUSIONS: Percutaneous vertebroplasty produces higher intravertebral pressures in vertebrae containing a simulated lytic metastasis than in intact vertebrae. Pressures generated in the tumor specimens are sufficiently elevated to cause embolic phenomena.
Authors:
Declan Reidy; Henry Ahn; Payam Mousavi; Joel Finkelstein; Cari M Whyne
Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, Non-P.H.S.    
Journal Detail:
Title:  Spine     Volume:  28     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-16     Completed Date:  2004-03-29     Revised Date:  2009-07-09    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1534-9     Citation Subset:  IM    
Affiliation:
Orthopaedic Biomechanics Laboratory, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Biomechanics
Bone Cements / pharmacology
Cadaver
Humans
Lumbar Vertebrae / drug effects,  physiopathology*,  surgery
Neoplasm Transplantation / methods
Orthopedic Procedures / methods*
Polymethyl Methacrylate / pharmacology
Pressure
Spinal Neoplasms / physiopathology*,  secondary,  surgery
Thoracic Vertebrae / drug effects,  physiopathology*,  surgery
Chemical
Reg. No./Substance:
0/Bone Cements; 9011-14-7/Polymethyl Methacrylate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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