Abstract
BackgroundClinical results have shown that different vertebral heights have been restored post-augmentation of osteoporotic vertebral compression fractures (OVCFs) and the treatment results are consistent. However, no significant results regarding biomechanical effects post-augmentation have been found with different types of vertebral deformity or vertebral heights by biomechanical analysis. Therefore, the present study aimed to investigate the biomechanical effects between different vertebral heights of OVCFs before and after augmentation using three-dimensional finite element analysis.MethodsFour patients with OVCFs of T12 underwent computed tomography (CT) of the T11-L1 levels. The CT images were reconstructed as simulated three-dimensional finite-element models of the T11-L1 levels (before and after the T12 vertebra was augmented with cement). Four different kinds of vertebral height models included Genant semi-quantitative grades 0, 1, 2, and 3, which simulated unilateral augmentation. These models were assumed to represent vertical compression and flexion, left flexion, and right flexion loads, and the von Mises stresses of the T12 vertebral body were assessed under different vertebral heights before and after bone cement augmentation.ResultsData showed that the von Mises stresses significantly increased under four loads of OVCFs of the T12 vertebral body before the operation from grade 0 to grade 3 vertebral heights. The maximum stress of grade 3 vertebral height pre-augmentation was produced at approximately 200%, and at more than 200% for grade 0. The von Mises stresses were significantly different between different vertebral heights preoperatively. The von Mises stresses of the T12 vertebral body significantly decreased in four different loads and at different vertebral body heights (grades 0–3) after augmentation. There was no significant difference between the von Mises stresses of grade 0, 1, and 3 vertebral heights postoperatively. The von Mises stress significantly decreased between pre-augmentation and post-augmentation in T12 OVCF models of grade 0–3 vertebral heights.ConclusionVertebral augmentation can sufficiently reduce von Mises stresses at different heights of OVCFs of the vertebral body, although this technique does not completely restore vertebral height to the anatomical criteria.
Highlights
Clinical results have shown that different vertebral heights have been restored post-augmentation of osteoporotic vertebral compression fractures (OVCFs) and the treatment results are consistent
Osteoporotic vertebral compression fracture (OVCF) is a common disease in the elderly population accompanied by decreased bone mineral density [1], which can cause acute or chronic back pain, functional limitations of the spine, a thoracolumbar vertebral deformity, vertebral height (VH) loss, and deterioration of quality of life [2, 3]
percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) can relieve the clinical symptoms of patients with OVCFs through vertebral augmentation (VA), the VH of these patients cannot be fully reduced [6, 7], and there are no acceptable clinical reduction criteria
Summary
Clinical results have shown that different vertebral heights have been restored post-augmentation of osteoporotic vertebral compression fractures (OVCFs) and the treatment results are consistent. Relieve pain fast, and achieve restoration of VH for the treatment of OVCFs, two minimally invasive VA procedures, percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP), have been performed by percutaneously injecting bone cement into the fractured vertebral body [6, 7]. Two kinds of bone cement injection methods are used in PKP and PVP: unilateral or bilateral injection The benefit of these minimally invasive procedures compared to conservative treatment or open surgery is better pain relief and functional spine improvement [4]. When bone cement is injected into the vertebral body, it may have analgesic effects by consolidating micro-fractures and reducing the mechanical stress generated by body weight and with activity, and it may destroy bone nerve endings by a cytotoxic and exothermal action in the course of cement polymerization [9]
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