Mineralized Collagen Incorporated Polymethyl Methacrylate Bone Cement for Percutaneous Vertebroplasty and Percutaneous Kyphoplasty

Percutaneous vertebroplasty (PVP) is a minimally invasive intervention widely used for relief of pain caused by osteoporotic, traumatic, or neoplastic vertebral fractures. During PVP, polymethyl methacrylate (bone cement) is injected directly into the vertebral body via a vertebral pedicle to partially restore the vertebral body height, to stabilize bone trabeculae and to alleviate pain. Though the procedure is minimally invasive, complications are not rare; however, mostly, they are not clinically significant. Potentially serious complications of PVP include pulmonary embolism with polymethyl methacrylate with variety of manifestations ranging from asymptomatic postoperative x-ray findings to life-threatening extravasation (cement "leakage") which is quite rare and fatal. Epidemiology, pathogenesis, clinical and radiological signs of pulmonary embolism in PVP and approaches to treatment are discussed in this review of literature. The article also describes two clinical cases of pulmonary embolism in patients underwent PVP for hemangioma of the vertebral body with severe pain syndrome are also described.

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Mineralized Collagen Modified Polymethyl Methacrylate Bone Cement for Osteoporotic Compression Vertebral Fracture at 1-Year Follow-up

Spine ◽

10.1097/brs.0000000000002971 ◽

2019 ◽

Vol 44 (12) ◽

pp. 827-838 ◽

Cited By ~ 1

Author(s):

Jinjin Zhu ◽

Kai Zhang ◽

Kefeng Luo ◽

Zhiye Qiu ◽

Shuhui Yang ◽

...

Keyword(s):

Vertebral Fracture ◽

Bone Cement ◽

Polymethyl Methacrylate ◽

Mineralized Collagen

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The clinical results of treating Kummell’s disease with mineralized collagen modified polymethyl methacrylate

Journal of Biomaterials Applications ◽

10.1177/0885328221990821 ◽

2021 ◽

pp. 088532822199082

Author(s):

Xi Wang ◽

Jin Xu ◽

Jianming Kou ◽

Wei Tian ◽

Chong Gao ◽

...

Keyword(s):

Visual Analogue Scale ◽

Bone Cement ◽

Polymethyl Methacrylate ◽

Vertebral Body ◽

Analogue Scale ◽

Cement Leakage ◽

Clinical Results ◽

Kummell’S Disease ◽

Kümmell’S Disease ◽

Mineralized Collagen

To investigate the clinical results of treating Kummell’s Disease by using mineralized collagen modified polymethyl methacrylate bone cement, 23 cases (23 vertebras) who sustained Kummell’s Disease treated with mineralized collagen modified polymethyl methacrylate bone cement from July 2017 to February 2019 were reviewed retrospectively. The visual analogue scale, vertebral body height, Cobb angle, CT values pre-operation and post-operation as well as incidence of complications were observed. All the patients were successfully followed up with an average period of 11.3 months (ranging from 6 to 12 months). The patients could ambulate on the second day after the operation. The visual analogue scale scores significantly decreased from two days after the operation to the last follow-up compared with that before the operation ( p < 0.05); the average vertebral height and local Cobb angle had significant recovery ( p < 0.05); the CT value of the treated vertebra significantly increased compared with that before the operation ( p < 0.05). Bone cement leakage occurred in one case, anterior edge leakage occurred in one case, and no clinical symptoms caused by bone cement leakage occurred. No re-fracture of the treated vertebral body or adjacent vertebral bodies were observed in the follow-ups. With good osteogenic activity and degradable absorption characteristics, mineralized collagen was compounded with the existing polymethyl methacrylate bone cement to reduce its strength in the vertebral body and enhance biocompatibility, the incidence of adjacent vertebral fractures and re-fractures within the injured vertebrae is significantly reduced, and good clinical results are obtained, which is worthy of popularization.

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Influence of bone cement distribution on outcomes following percutaneous vertebroplasty: a retrospective matched-cohort study

Journal of International Medical Research ◽

10.1177/03000605211022287 ◽

2021 ◽

Vol 49 (7) ◽

pp. 030006052110222

Author(s):

Ling Mo ◽

Zixian Wu ◽

De Liang ◽

Linqiang Y ◽

Zhuoyan Cai ◽

...

Keyword(s):

Cohort Study ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Matched Cohort ◽

Matched Cohort Study ◽

Cement Distribution ◽

Group A ◽

Group B

Objective To evaluate the influence of insufficient bone cement distribution on outcomes following percutaneous vertebroplasty (PVP). Methods This retrospective matched-cohort study included patients 50–90 years of age who had undergone PVP for single level vertebral compression fractures (VCFs) from February 2015 to December 2018. Insufficient (Group A)/sufficient (Group B) distribution of bone cement in the fracture area was assessed from pre- and post-operative computed tomography (CT) images. Assessments were before, 3-days post-procedure, and at the last follow-up visit (≥12 months). Result Of the 270 eligible patients, there were 54 matched pairs. On post-operative day 3 and at the last follow-up visit, significantly greater visual analogue scale (VAS) pain scores and Oswestry Disability Index (ODI) scores were obtained in Group B over Group A, while kyphotic angles (KAs) and vertebral height (VH) loss were significantly larger in Group A compared with Group B. Incidence of asymptomatic cement leakage and re-collapse of cemented vertebrae were also greater in Group A compared with Group B. Conclusions Insufficient cement distribution may relate to less pain relief and result in progressive vertebral collapse and kyphotic deformity post-PVP.

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Percutaneous vertebroplasty versus kyphoplasty for the treatment of neurologically intact osteoporotic Kümmell’s disease

BMC Surgery ◽

10.1186/s12893-021-01057-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shou-qian Dai ◽

Rong-qing Qin ◽

Xiu Shi ◽

Hui-lin Yang

Keyword(s):

Blood Loss ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Cement Leakage ◽

Intraoperative Blood Loss ◽

Surgical Time ◽

Significant Difference ◽

Neurologically Intact ◽

Operation Cost

Abstract Background Percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used to treat neurologically intact osteoporotic Kümmell’s disease (KD), but it is still unclear which treatment is more advantageous. Our study aimed to compare and investigate the safety and clinical efficacy of PVP and PKP in the treatment of KD. Methods The relevant data that 64 patients of neurologically intact osteoporotic KD receiving PVP (30 patients) or PKP (34 patients) were analyzed. Surgical time, operation costs, intraoperative blood loss, volume of bone cement injection, and fluoroscopy times were compared. Occurrence of cement leakage, transient fever and re-fracture were recorded. Universal indicators of visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated separately before surgery and at 1 day, 6 months, 1 year, 2 years and the final follow-up after operation. The height of anterior edge of the affected vertebra and the Cobb’s angle were assessed by imaging. Results All patients were followed up for at least 24 months. The volume of bone cement injection, intraoperative blood loss, occurrence of bone cement leakage, transient fever and re-fracture between two groups showed no significant difference. The surgical time, the operation cost and fluoroscopy times of the PKP group was significantly higher than that of the PVP group. The post-operative VAS, ODI scores, the height of the anterior edge of the injured vertebrae and kyphosis deformity were significantly improved in both groups compared with the pre-operation. The improvement of vertebral height and kyphosis deformity in PKP group was significantly better than that in the PVP group at every same time point during the follow-up periods, but the VAS and ODI scores between the two groups showed no significant difference. Conclusion PVP and PKP can both significantly alleviate the pain of patients with KD and obtain good clinical efficacy and safety. By contrast, PKP can achieve better imaging height and kyphosis correction, while PVP has the advantages of shorter operation time, less radiation volume and operation cost.

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Risk factors for thoracolumbar pain following percutaneous vertebroplasty for osteoporotic vertebral compression fractures

Journal of International Medical Research ◽

10.1177/0300060521989468 ◽

2021 ◽

Vol 49 (1) ◽

pp. 030006052198946

Author(s):

Xiaoguang Fan ◽

Sha Li ◽

Xianshang Zeng ◽

Weiguang Yu ◽

Xiangzhen Liu

Keyword(s):

Risk Factors ◽

Bone Cement ◽

Percutaneous Vertebroplasty ◽

Vertebral Compression Fractures ◽

Mineral Density ◽

Eligibility Criteria ◽

Compression Fractures ◽

Logistic Analysis ◽

The Difference ◽

Poor Outcomes

Objective To explore possible risk factors for poor outcomes following percutaneous vertebroplasty (PV) for painful osteoporotic compression fractures of thoracolumbar vertebra. Methods This was a retrospective review of data from patients who underwent PV at our institution over a ten-year period to evaluate the association between possible risk factors and thoracolumbar pain (T11-L2). According to the difference between pre- and post-operative visual analogue scale (VAS) scores for pain, patients were separated into poor relief (PR; <4) and good relief (GR; ≥4) of pain. Results Of the 750 patients identified, 630 (PR group, n =310; GR group, n = 320) fulfilled the eligibility criteria. Multivariate binary logistic analysis showed that bone mineral density (BMD), >2 fractured vertebral bodies, maldistribution of bone cement, <5 ml bone cement injected into a single vertebral body and thoracolumbar fascia injury prior to surgery were independent risk factors associated with thoracolumbar pain following PV. Conclusion Although prospective controlled studies are required to confirm our results, this review suggests that the above factors should be taken into account when selecting patients for PV.

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N-acetyl cysteine prevents polymethyl methacrylate bone cement extract-induced cell death and functional suppression of rat primary osteoblasts

Journal of Biomedical Materials Research Part A ◽

10.1002/jbm.a.32336 ◽

2010 ◽

Vol 92A (1) ◽

pp. 285-296 ◽

Cited By ~ 16

Author(s):

Hideki Aita ◽

Naoki Tsukimura ◽

Masahiro Yamada ◽

Norio Hori ◽

Katsutoshi Kubo ◽

...

Keyword(s):

Cell Death ◽

Bone Cement ◽

Polymethyl Methacrylate ◽

Acetyl Cysteine ◽

Primary Osteoblasts

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A Comparative Study on the Treatment of Osteoporotic Vertebral Compression Fracture with Different Injection Volumes of High Viscosity Bone Cement in Percutaneous Vertebroplasty

10.36468/pharmaceutical-sciences.spl.19 ◽

2020 ◽

Vol 20 (s2) ◽

Author(s):

S. A. Song ◽

L. Shen ◽

W. Yukai ◽

Z. Changqing

Keyword(s):

Comparative Study ◽

Bone Cement ◽

Vertebral Compression Fracture ◽

Percutaneous Vertebroplasty ◽

Compression Fracture ◽

High Viscosity ◽

Osteoporotic Vertebral Compression Fracture

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Experimental study of the antibacterial activity of the lytic Staphylococcus aureus bacteriophage ph20 and lytic Pseudomonas aeruginosa bacteriophage ph57 during modelling of its impregnation into poly(methylmetacrylate) orthopedic implants (bone cement)

Annals of the Russian academy of medical sciences ◽

10.15690/vramn905 ◽

2018 ◽

Vol 73 (1) ◽

pp. 59-68 ◽

Cited By ~ 2

Author(s):

A. G. Samokhin ◽

Ju. N. Kozlova ◽

D. V. Korneev ◽

O. S. Taranov ◽

E. A. Fedorov ◽

...

Keyword(s):

Antibacterial Activity ◽

Bone Cement ◽

Polymethyl Methacrylate ◽

Bacterial Colonization ◽

Experimental Studies ◽

Orthopedic Implants ◽

Polymerization Process ◽

Polymerization Reaction ◽

Chemical Components

Background: The problem of bacterial colonization of implants used in medical practice continues to be relevant regardless of the material of the implant. Particular attention deserves polymeric implants, which are prepared ex tempore from polymethyl methacrylate, for example - duting orthopedic surgical interventions (so-called "bone cement"). The protection of such implants by antibiotic impregnation is subjected to multiple criticisms, therefore, as an alternative to antibiotics, lytic bacteriophages with a number of unique advantages can be used - however, no experimental studies have been published on the possibility of impregnating bacteriophages into polymethyl methacrylate and their antibacterial activity assessment under such conditions.Aims: to evaluate the possibility of physical placement of bacteriophages in polymethylmethacrylate and to characterize the lytic antibacterial effect of two different strains of bacteriophages when impregnated into polymer carrier ex tempore during the polymerization process in in vitro model.Materials and methods: First stage - Atomic force microscopy (AFM) of polymethyl methacrylate samples for medical purposes was used to determine the presence and size of caverns in polymethyl methacrylate after completion of its polymerization at various reaction temperatures (+6…+25°C and +18…+50°C).The second stage was performed in vitro and included an impregnation of two different bacteriophage strains (phage ph20 active against S. aureus and ph57 active against Ps. aeruginosa) into polymethyl methacrylate during the polymerization process, followed by determination of their antibacterial activity.Results: ACM showed the possibility of bacteriophages placement in the cavities of polymethyl methacrylate - the median of the section and the depth of cavities on the outer surface of the polymer sample polymerized at +18…+50°C were 100.0 and 40.0 nm, respectively, and on the surface of the transverse cleavage of the sample - 120.0 and 100.0 nm, respectively, which statistically did not differ from the geometric dimensions of the caverns of the sample polymerized at a temperature of +6…+25°C.The study of antibacterial activity showed that the ph20 bacteriophage impregnated in polymethyl methacrylate at +6…+25°C lost its effective titer within the first six days after the start of the experiment, while the phage ph57 retained an effective titer for at least 13 days.Conclusion: the study confirmed the possibility of bacteriophages impregnation into medical grade polymethyl methacrylate, maintaining the effective titer of the bacteriophage during phage emission into the external environment, which opens the way for the possible application of this method of bacteriophage delivery in clinical practice. It is also assumed that certain bacteriophages are susceptible to aggressive influences from the chemical components of "bone cement" and / or polymerization reaction products, which requires strict selection of bacteriophage strains that could be suitable for this method of delivery.

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