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Abstract
EPFs sustained during VCFs degrade the disk's ability to develop IDP under load. This inability to develop pressure in combination with residual kyphotic deformity increases the risk for adjacent vertebral fractures. We tested the hypothesis that StaXx FX reduces kyphosis and endplate deformity following vertebral compression fracture, restoring disk mechanics. Eight thoracolumbar, 5-vertebrae segments were tested. A void was selectively created in the middle vertebra. The specimens were compressed until EPF and to a grade I-II VCF. PEEK wafer kyphoplasty was then performed. The specimens were then tested in flexion-extension (±6 Nm) under 400-N preload intact, after EPF, VCF, and kyphoplasty. Endplate deformity, kyphosis, and IDP adjacent to the fractured body were measured. Vertebral body height at the point of maximal endplate deformity decreased after EPF and VCF and was partially corrected after StaXx FX, remaining less than intact (P = .047). Anterior vertebral height decreased after VCF (P = .002) and was partially restored with StaXx FX, remaining less than intact (P = .015). Vertebral kyphosis increased after VCF (P < .001) and reduced after StaXx FX, remaining greater than intact (P = .03). EPF reduced IDP in the affected disk in compression-flexion loading (P < .001), which was restored after StaXx FX (P = 1.0). IDP in the unaffected disk did not change during testing (P > .3). StaXx FX reduced endplate deformity and kyphosis, and significantly increased anterior height following VCF. Although height and kyphosis were not fully corrected, the disk's ability to pressurize under load was restored.
Highlights
MethodsA void was selectively created in the middle vertebra
AND PURPOSE: EPFs sustained during VCFs degrade the disk’s ability to develop IDP under load
Vertebral body height at the point of maximal endplate deformity decreased after EPF and VCF and was partially corrected after StaXx FX, remaining less than intact (P ϭ .047)
Summary
A void was selectively created in the middle vertebra. The specimens were compressed until EPF and to a grade I–II VCF. The specimens were tested in flexionextension (Ϯ6 Nm) under 400-N preload intact, after EPF, VCF, and kyphoplasty. Kyphosis, and IDP adjacent to the fractured body were measured. All specimens were radiographically screened to exclude pre-existing osteoporotic fractures within the tested levels, severe disk space collapse, bridging osteophytes, and vertebral neoplastic disease. Bone mineral attenuation of the index and adjacent levels was determined by using dual energy x-ray absorptiometry (Lunar Prodigy/DPX Series; GE Healthcare, Waukesha, Wisconsin). The specimens were thawed at room temperature (20°C) 24 hours before testing. The most cephalad and caudal vertebrae of each specimen were anchored in cups by using bone cement and pins
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