Vertebral balloon kyphoplasty versus vertebral body stenting in non-osteoporotic vertebral compression fractures at the thoracolumbar junction: a comparative radiological study and finite element analysis (BONEXP study)

If conservative treatment of osteoporotic vertebral compression fractures fails, vertebro- or kyphoplasty is indicated. Usually, polymethylmethacrylate cement (PMMA) is applied coming along with many disadvantageous features. Aluminum-free glass-polyalkenoate cement (GPC) appears to be a benefit alternative material. This study aimed at comparing the mean stress values in human vertebrae after kyphoplasty with PMMA and GPC (IlluminOss™) at hand of a finite element analysis. Three models were created performing kyphoplasty using PMMA or IlluminOss™, respectively, at two native, human lumbar vertebrae (L4) while one remains intact. Finite element analysis was performed using CT-scans of every vertebra. Moreover the PMMA-treated vertebra was used as a model as analyses were executed using material data of PMMA and of GPC. The unimpaired, spongious bone showed potentials of 0.25 MPa maximally. After augmentation stress levels showed fivefold increase, rising from externally to internally, revealing stress peaks at the ventral border of the spinal canal. At central areas of cement 1 MPa is measured in both types of cement. Around these central areas the von Mises stress decreased about 25-50% (0.5-0.75 MPa). If workload of 500 N was applied, the stress appeared to be more centralized at the IlluminOss™-model, similar to the unimpaired. Considering the endplates the GPC model also closely resembles the unimpaired. Comparing the PMMA-treated vertebral body and the GPC-simulation, there is an obvious difference. While the PMMA-treated model showed a central stress peak of 5 MPa, the GPC-simulation of the same vertebral body presents lower stress of 1.2-2.5 MPa. Finite element analysis showed that IlluminOss™ (GPC), used in kyphoplasty of vertebral bodies, creates lower level stress and strain compared to standardly used PMMA, leading to lower stress concentrations on the cranial and caudal vertebral surface especially. GPC appears to own advantageous biological and clinical relevant features.

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Faculty Opinions recommendation of Vertebral body stenting versus kyphoplasty for the treatment of osteoporotic vertebral compression fractures: a randomized trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718006443.793477058 ◽

2013 ◽

Author(s):

Toshio Matsumoto

Keyword(s):

Randomized Trial ◽

Vertebral Body ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Vertebral Body Stenting

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Treatment of Thoracolumbar Osteoporotic Vertebral Compression Fractures with Vertebral Body Stenting: A Prospective Study

Global Spine Journal ◽

10.1055/s-0036-1582759 ◽

2016 ◽

Vol 6 (1_suppl) ◽

pp. s-0036-1582759-s-0036-1582759

Author(s):

Abdulrazzaq Alobaid ◽

Eslam Shehata ◽

Abdulaziz Almutair

Keyword(s):

Prospective Study ◽

Vertebral Body ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

A Prospective Study ◽

Vertebral Body Stenting

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Height and Volume Restoration In Osteoporotic Vertebral Compression Fractures: A Biomechanical Comparison Of Standard Balloon Kyphoplasty Versus Tektona In A Cadaveric Fracture Model

10.21203/rs.3.rs-60485/v1 ◽

2020 ◽

Author(s):

Antonio Krüger ◽

Martin Bäumlein ◽

Tom Knauf ◽

Hugues Pascal-Moussellard ◽

Steffen Ruchholtz ◽

...

Keyword(s):

Vertebral Body ◽

Balloon Kyphoplasty ◽

Ct Scans ◽

Matched Pair ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Before And After ◽

Vertebral Bodies ◽

The Difference

Abstract Background: Standard balloon kyphoplasty represents a well-established treatment option for osteoporotic vertebral compression fractures. Aim of the present study was to evaluate two different methods of percutaneous augmentation (standard Balloon kyphoplasty (BKP) versus Tektona (TEK)) with respect to height restoration. Methods: Four-teen vertebral bodies of two female cadavers were examined. Fractures were created using a standardized protocol. CT-scans were taken before and after fracture, as well as after treatment. Afterwards two groups were randomly assigned in a matched pair design: 7 vertebral bodies (VB) were treated with (BKP, Kyphon, Medtronic) and 7 vertebral bodies by TEK (Spineart, Switzerland) Anterior, central and posterior vertebral body heights were evaluated by CT-scans. Volumetry was performed using the CT-scans at three different timepoints. Results: Values before fracture represent 100 %. The anterior height after fracture was reduced to 75,99 (± 4,8) % for the BKP group and to 76,54 (± 9,17) % in the TEK Group. Statistically there was no difference for the groups (p = 1). After treatment the values increased to 93,06 (±5) % for the BKP Group and 87,71 (±6,2) % for the TEK Group. The difference before and after treatment was significant for both groups (BKP p =0,0006; TEK p= 0,03). Within the groups, there was no difference (p=0,13). The Volume of the vertebral body was reduced to 82,29 (±8,4) % in the BKP Group and to 76,54 (±8,6) % in the TEK Group. After treatment the volume was 89,26 (±6,9) % for the BKP Group and 88,80 (±8,7) % for the TEK Group. The difference before and after treatment was significant only for the TEK group (BKP p =0,0728 n.s.; TEK p= 0,0175). Within the groups, there was no difference (p=0,2). The average cement volume used was 6,1 (range 3,6 - 9 ml) for the BKP group and 5,3 (3 - 7,2 ml) for the TEK group respectively.Conclusions: Based on our results the new System Tektona in osteoporotic compression fractures might represent a promising alternative for the clinical setting, especially preserving bone. Further biomechanical tests and clinical studies have to proof Tektona`s capabilities.

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Height and volume restoration in osteoporotic vertebral compression fractures: a biomechanical comparison of standard balloon kyphoplasty versus Tektona® in a cadaveric fracture model

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03899-7 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Antonio Krüger ◽

Martin Bäumlein ◽

Tom Knauf ◽

Hugues Pascal-Moussellard ◽

Steffen Ruchholtz ◽

...

Keyword(s):

Vertebral Body ◽

Balloon Kyphoplasty ◽

Ct Scans ◽

Matched Pair ◽

Vertebral Compression Fractures ◽

Osteoporotic Vertebral Compression Fractures ◽

Compression Fractures ◽

Before And After ◽

Vertebral Bodies ◽

The Difference

Abstract Background Standard balloon kyphoplasty represents a well-established treatment option for osteoporotic vertebral compression fractures. Aim of the present study was to evaluate two different methods of percutaneous augmentation (standard balloon kyphoplasty (BKP) versus Tektona® (TEK)) with respect to height restoration. Methods Four-teen vertebral bodies of two female cadavers were examined. Fractures were created using a standardized protocol. CT-scans were taken before and after fracture, as well as after treatment. Afterwards two groups were randomly assigned in a matched pair design: 7 vertebral bodies (VB) were treated with BKP (Kyphon, Medtronic) and 7 vertebral bodies by TEK (Spineart, Switzerland) Anterior, central and posterior vertebral body heights were evaluated by CT-scans. Volumetry was performed using the CT-scans at three different timepoints. Results Values before fracture represent 100%. The anterior height after fracture was reduced to 75.99 (± 4.8) % for the BKP group and to 76.54 (± 9.17) % in the TEK Group. Statistically there was no difference for the groups (p = 1). After treatment the values increased to 93.06 (± 5) % for the BKP Group and 87.71 (± 6.2) % for the TEK Group. The difference before and after treatment was significant for both groups (BKP p = 0.0006; TEK p = 0.03). Within the groups, there was no difference (p = 0.13). The Volume of the vertebral body was reduced to 82.29 (± 8.4) % in the BKP Group and to 76.54 (± 8.6) % in the TEK Group. After treatment the volume was 89.26 (± 6.9) % for the BKP Group and 88.80 (± 8.7) % for the TEK Group. The difference before and after treatment was significant only for the TEK group (BKP p = 0.0728 n.s.; TEK p = 0.0175). Within the groups, there was no difference (p = 0.2). The average cement volume used was 6.1 (range 3.6–9 ml) for the BKP group and 5.3 (3–7.2 ml) for the TEK group respectively. Conclusions Based on our results the new System Tektona® in osteoporotic compression fractures might represent a promising alternative for the clinical setting, especially preserving bone. Further biomechanical tests and clinical studies have to proof Tektona®`s capabilities.

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