Skip to main content
Erschienen in: European Spine Journal 8/2011

01.08.2011 | Original Article

Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae

verfasst von: BaiLing Chen, YiQiang Li, DengHui Xie, XiaoXi Yang, ZhaoMin Zheng

Erschienen in: European Spine Journal | Ausgabe 8/2011

Einloggen, um Zugang zu erhalten

Abstract

Percutaneous kyphoplasty (PKP) has been used to treat osteoporotic vertebral compression fractures for over 10 years; however, clinically speaking it is still controversial as to whether the use of unipedicular PKP or bipedicular PKP is best. Our study aimed to compare the different effects of unipedicular PKP and bipedicular PKP on the stiffness of compression fractured vertebral bodies (VBs), as well as to assess how cement distribution affect the bilateral biomechanical balance of the VBs. During this study, 30 thoracic VBs were compressed, creating vertebral compression fracture models; then they were augmented by unipedicular (group A and B) PKP and bipedicular (group C) PKP. In group A (unipedicular PKP), the cement was injected into one side and the augmentation was limited to the same side of the VB. In group B (unipedicular PKP), the cement was injected at only one side but the augmentation extended across the midline and filled both sides of the VB. In group C (bipedicular PKP), the cement was injected into both sides and thus achieved the bilateral augmentation. For the unipedicular PKP, the amount of cement injected was 15% of the original VB volume; while in bipedicular PKP, the amount of cement injected was a total of 20% of the original VB volume (10% was injected into each side). Using a MTS-858, we examined three phases of the VBs (intact, pre-augmented, post-augmented), by applying loads axially to the total vertebra and bilateral sides of the vertebra for each of three cycles, respectively. The changes of force and displacement were then recorded and the stiffness of the total vertebra and bilateral sides of the vertebra were calculated. For the pre-augmentation stage, the total VB stiffness of groups A, B and C significantly decreased when the compression fracture models were established (P < 0.05). After the cement augmentation (the post-augmentation stage), both groups A and B, showed that the stiffness could be restored to the initial, intact state; however, in group C, the stiffness was significantly higher than the initial, intact state (P < 0.01). The stiffness of the augmented side of group A was significantly higher than the non-augmented side (P < 0.001). In groups B and C, no significant differences were observed in the stiffness between total VB and each individual side. Thus, we can conclude that both unipedicular PKP and bipedicular PKP significantly increase the total VB stiffness. Bipedicular PKP creates stiffness uniformly across both sides of the vertebrae, while unipedicular PKP, creates a biomechanical balance depending on the distribution of cement. If bone cement is augmented only on one side, the stiffness of non-augmented side will be significantly lower than the augmented side, which might lead to an imbalance of stress on the VB. However, when cement augmentation crosses the midline, stiffness of both sides increase comparatively and biomechanical balance is thus achieved.
Literatur
1.
Zurück zum Zitat Al-Ali F, Barrow T, Luke K (2009) Vertebroplasty: what is important and what is not. Am J Neuroradiol 30(10):1835–1839PubMedCrossRef Al-Ali F, Barrow T, Luke K (2009) Vertebroplasty: what is important and what is not. Am J Neuroradiol 30(10):1835–1839PubMedCrossRef
2.
Zurück zum Zitat Belkoff SM, Mathis JM, Jasper LE, Deramond H (2001) The biomechanics of vertebroplasty: the effect of cement volume on mechanical behavior. Spine 26(14):1537–1541PubMedCrossRef Belkoff SM, Mathis JM, Jasper LE, Deramond H (2001) The biomechanics of vertebroplasty: the effect of cement volume on mechanical behavior. Spine 26(14):1537–1541PubMedCrossRef
3.
Zurück zum Zitat Boszczyk B (2010) Volume matters: a review of procedural details of two randomized controlled vertebroplasty trials of 2009. Eur Spine J 19:1837–1840PubMedCrossRef Boszczyk B (2010) Volume matters: a review of procedural details of two randomized controlled vertebroplasty trials of 2009. Eur Spine J 19:1837–1840PubMedCrossRef
4.
Zurück zum Zitat Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361(6):557–568PubMedCrossRef Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med 361(6):557–568PubMedCrossRef
5.
Zurück zum Zitat Chang WS, Lee SH, Choi WG, Choi G, Jo BJ (2007) Unipedicular vertebroplasty for osteoporotic compression fracture using an individualized needle insertion angle. Clin J Pain 23(9):767–773PubMedCrossRef Chang WS, Lee SH, Choi WG, Choi G, Jo BJ (2007) Unipedicular vertebroplasty for osteoporotic compression fracture using an individualized needle insertion angle. Clin J Pain 23(9):767–773PubMedCrossRef
6.
Zurück zum Zitat Furtado N, Oakland RJ, Wilcox RK, Hall RM (2007) A biomechanical investigation of vertebroplasty in osteoporotic compression fractures and in prophylactic vertebral reinforcement. Spine 32(17):480–487CrossRef Furtado N, Oakland RJ, Wilcox RK, Hall RM (2007) A biomechanical investigation of vertebroplasty in osteoporotic compression fractures and in prophylactic vertebral reinforcement. Spine 32(17):480–487CrossRef
7.
Zurück zum Zitat Fyhrie DP, Vashishth D (2000) Bone stiffness predicts strength similarly for human vertebral cancellous bone in compression and for cortical bone in tension. Bone 26(2):169–173PubMedCrossRef Fyhrie DP, Vashishth D (2000) Bone stiffness predicts strength similarly for human vertebral cancellous bone in compression and for cortical bone in tension. Bone 26(2):169–173PubMedCrossRef
8.
Zurück zum Zitat Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and Kyphoplasty: a systematic review of 69 clinical studies. Spine 31(17):1983–2001PubMedCrossRef Hulme PA, Krebs J, Ferguson SJ, Berlemann U (2006) Vertebroplasty and Kyphoplasty: a systematic review of 69 clinical studies. Spine 31(17):1983–2001PubMedCrossRef
9.
Zurück zum Zitat Hou FJ, Lang SM, Hoshaw SJ, Reimann DA, Fyhrie DP (1998) Human vertebral body apparent and hard tissue stiffness. J Biomech 31(11):1009–1015PubMedCrossRef Hou FJ, Lang SM, Hoshaw SJ, Reimann DA, Fyhrie DP (1998) Human vertebral body apparent and hard tissue stiffness. J Biomech 31(11):1009–1015PubMedCrossRef
10.
Zurück zum Zitat Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361(6):569–579PubMedCrossRef Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med 361(6):569–579PubMedCrossRef
11.
Zurück zum Zitat Kaufmann TJ, Trout AT, Kallmes DF (2006) The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 27(9):1933–1937PubMed Kaufmann TJ, Trout AT, Kallmes DF (2006) The effects of cement volume on clinical outcomes of percutaneous vertebroplasty. AJNR Am J Neuroradiol 27(9):1933–1937PubMed
12.
Zurück zum Zitat Keaveny TM, Wachtel EF, Ford CM, Hayes WC (1994) Differences between the tensile and compressive strengths of bovine tibial trabecular bone depend on modulus. J Biomech 27(9):1137–1146PubMedCrossRef Keaveny TM, Wachtel EF, Ford CM, Hayes WC (1994) Differences between the tensile and compressive strengths of bovine tibial trabecular bone depend on modulus. J Biomech 27(9):1137–1146PubMedCrossRef
13.
Zurück zum Zitat Ken K, Kenji T, Masamichi K, Misako Y, Shinjiro S, Yasuo N (2006) Unilateral transpedicular percutaneous vertebroplasty using puncture simulation. Radiat Med 24(3):187–194CrossRef Ken K, Kenji T, Masamichi K, Misako Y, Shinjiro S, Yasuo N (2006) Unilateral transpedicular percutaneous vertebroplasty using puncture simulation. Radiat Med 24(3):187–194CrossRef
14.
Zurück zum Zitat Kim MJ, Lindsey DP, Hannibal M, Alamin TF (2006) Vertebroplasty versus kyphoplasty: biomechanical behavior under repetitive loading conditions. Spine 31(18):2079–2084PubMedCrossRef Kim MJ, Lindsey DP, Hannibal M, Alamin TF (2006) Vertebroplasty versus kyphoplasty: biomechanical behavior under repetitive loading conditions. Spine 31(18):2079–2084PubMedCrossRef
15.
Zurück zum Zitat Liebschner MAK, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26(14):1547–1554PubMedCrossRef Liebschner MAK, Rosenberg WS, Keaveny TM (2001) Effects of bone cement volume and distribution on vertebral stiffness after vertebroplasty. Spine 26(14):1547–1554PubMedCrossRef
16.
Zurück zum Zitat Luo J, Daines L, Charalambous A, Adams MA, Annesley-Williams DJ, Dolan P (2009) Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine 34(26):2865–2873PubMedCrossRef Luo J, Daines L, Charalambous A, Adams MA, Annesley-Williams DJ, Dolan P (2009) Vertebroplasty: only small cement volumes are required to normalize stress distributions on the vertebral bodies. Spine 34(26):2865–2873PubMedCrossRef
17.
Zurück zum Zitat McGirt MJ, Parker SL, Wolinsky JL, Witham TF, Bydon A, Gokaslan ZL (2009) Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J 9(6):501–508PubMedCrossRef McGirt MJ, Parker SL, Wolinsky JL, Witham TF, Bydon A, Gokaslan ZL (2009) Vertebroplasty and kyphoplasty for the treatment of vertebral compression fractures: an evidenced-based review of the literature. Spine J 9(6):501–508PubMedCrossRef
18.
Zurück zum Zitat Molloy S, Mathis JM, Belkoff SM (2003) The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine 28(14):1555–1559PubMed Molloy S, Mathis JM, Belkoff SM (2003) The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine 28(14):1555–1559PubMed
19.
Zurück zum Zitat Papadopoulos EC, Osula FE, Gardner MJ, Shindle MK, Lane JM (2008) Unipedicular Balloon Kyphoplasty for the Treatment of Osteoporotic Vertebral Compression Fractures:Early Results. J Spinal Disor Tech 21(8):589–596CrossRef Papadopoulos EC, Osula FE, Gardner MJ, Shindle MK, Lane JM (2008) Unipedicular Balloon Kyphoplasty for the Treatment of Osteoporotic Vertebral Compression Fractures:Early Results. J Spinal Disor Tech 21(8):589–596CrossRef
20.
Zurück zum Zitat Steinmann J, Tingey CT, Cruz G, Dai Q (2005) Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine 30(2):201–205PubMedCrossRef Steinmann J, Tingey CT, Cruz G, Dai Q (2005) Biomechanical comparison of unipedicular versus bipedicular kyphoplasty. Spine 30(2):201–205PubMedCrossRef
21.
Zurück zum Zitat Tohmeh AG, Mathis JM, Fenton DC, Levine AM, Belkoff SM (1999) Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine 24(17):1772–1776PubMedCrossRef Tohmeh AG, Mathis JM, Fenton DC, Levine AM, Belkoff SM (1999) Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures. Spine 24(17):1772–1776PubMedCrossRef
22.
Zurück zum Zitat Walz M, Esmer E, Kolbow B (2006) CT-based analysis of cement distribution in unipedicular vertebroplasty. Der Unfallchirurg 109(11):932–939PubMedCrossRef Walz M, Esmer E, Kolbow B (2006) CT-based analysis of cement distribution in unipedicular vertebroplasty. Der Unfallchirurg 109(11):932–939PubMedCrossRef
23.
Zurück zum Zitat Wardlaw D, Cummings SR, Meirhaeghe JV, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373(9668):1016–1024PubMedCrossRef Wardlaw D, Cummings SR, Meirhaeghe JV, Bastian L, Tillman JB, Ranstam J, Eastell R, Shabe P, Talmadge K, Boonen S (2009) Efficacy and safety of balloon kyphoplasty compared with non-surgical care for vertebral compression fracture (FREE): a randomised controlled trial. Lancet 373(9668):1016–1024PubMedCrossRef
24.
Zurück zum Zitat Zou J, Yang HL, Lee S (2009) Single balloon vs double balloon kyphoplasty for treatment of osteoporotic vertebral compression fractures. Spine J 9(10):100 AbstractCrossRef Zou J, Yang HL, Lee S (2009) Single balloon vs double balloon kyphoplasty for treatment of osteoporotic vertebral compression fractures. Spine J 9(10):100 AbstractCrossRef
Metadaten
Titel
Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae
verfasst von
BaiLing Chen
YiQiang Li
DengHui Xie
XiaoXi Yang
ZhaoMin Zheng
Publikationsdatum
01.08.2011
Verlag
Springer-Verlag
Erschienen in
European Spine Journal / Ausgabe 8/2011
Print ISSN: 0940-6719
Elektronische ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-011-1744-3

Weitere Artikel der Ausgabe 8/2011

European Spine Journal 8/2011 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.