Abstract
Introduction. 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.
Highlights
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
Fracture reduction/fixation using titanium mesh implants (TMIs) without cement in osteoporotic sheep lumbar VCF resulted in bony fracture healing
Summary
In osteoporosis rarefication and thinning of intrinsic bone structures leads to reduced bone quality with inferior biomechanical properties [1, 2]. Disadvantageous of intravertebral applied PMMA cement is the change of vertebral elasticity parameters, which results in a change in biomechanical properties that increases the likelihood of adjacent fractures (reported incidence: 8–26%) [3, 7, 9, 13,14,15] Complications such as pulmonary embolism (up to 20%), cement leakage into the epidural space, or injury of adjunct neurovascular structures can occur due to exothermic reactions during the polymerization process (4–13%) [5, 7, 10, 11, 15]. It was hypothesized that (1) lumbar VCFs type A3.1 in osteoporotic sheep can be adequately restored using titanium mesh cages without cement application; (2) osteoporotic VCFs have bony healing capabilities that can be proven via micro-CT analyses; and (3) additional application of autologous spongiosa graft accelerates fracture healing with superior biomechanical properties
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