scholarly journals A Novel Bone Cement Injector Augments Osteoporotic Lumbar Pedicle Screw Channel: A Biomechanical Investigation

2021 ◽  
Author(s):  
Suochao Fu ◽  
Yu Zhang ◽  
Fuzhi Ai ◽  
Jianhua Wang ◽  
Zenghui Wu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Pedicle Screw ◽  
Statistical Significance ◽  
Cement Leakage ◽  
Full Length ◽  
Control Group ◽  
Insertion Torque ◽  
Screw Channel ◽  
Pull Out ◽  
Lumbar Pedicle

Abstract Background: The study aimed to invent a series of pedicle injectors and investigated the effects of the injectors with different number of holes on the augmentation of pedicle screw using bone cement in osteoporotic lumbar pedicle channel.Methods: This study used the biomechanical test module of polyurethane (Pacific Research Laboratory Corp, USA) to simulate the mechanical properties of human osteoporotic cancellous bone. The bone cement injectors were invented based on anatomical parameters of lumbar pedicle in Chinese. Mechanical test experiments were divided into three groups, namely, a local augmentation group, a full-length augmentation group, and a control group. The local augmentation group included three subgroups including 4 holes, 6 holes, and 8 holes and all holes were laterally placed. The full-length augmentation group was a straight-hole injector. The control group was defined that pedicle screws were inserted without any cement augmentation. Six screws were inserted in each group and the maximum insertion torque was recorded. After 24 hours of injecting acrylic bone cement, routine X-ray and CT examinations were performed to evaluate the distribution of bone cement. The axial pull-out force of screws was tested with the help of the MTS 858 mechanical tester.Results: The bone cement injectors were consisted of the sheaths and the steel-rods and the sheaths had different number of lateral holes. The control group had the lowest maximum insertion torque as compared with the 4-hole, 6-hole, 8-hole, and straight pore groups (P<0.01), but the difference between the 4-hole, 6-hole, 8-hole, and straight pore groups was no statistical significance. The control group had the lowest maximum axial pull-out force as compared with the other four groups (P<0.01). Subgroup analysis showed the 8-hole group (161.35±27.17 N) had the lower maximum axial pull-out force as compared with the 4-hole (217.29±49.68 N), 6-hole (228.39±57.83 N), and straight pore groups (237.55±35.96 N) (P<0.01). Bone cement was mainly distributed in 1/3 of the distal end of the screw among the 4-hole group, in the middle 1/3 and distal end of the screw among the 6-hole group, in the proximal 1/3 of the screw among the 8-hole group, and along the long axis of the whole screw body in the straight pore group. It might indicate that the 8-hole and straight-hole groups were more vulnerable to spinal canal cement leakage. After pullout, bone cement was also closely connected with the screw without any looseness or fragmentation.Conclusions: The bone cement injectors with different number of holes can be used to augment the pedicle screw channel. The pedicle screw augmented by the 4-hole or 6-hole sheath may have similar effects to the straight pore injector. However, the 8-hole injector may result in relatively lower pull-out strength and the straight pore injector has the risks of cement leakage as well as cement solidarization near the screw head.

scholarly journals Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution

2020 ◽  
Author(s):  
Jun Yan ◽  
Qiaohui Liu ◽  
Yanping Zheng ◽  
Ziqun Liu ◽  
Xinyu Liu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Lumbar Vertebrae ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Control Group ◽  
Pulsed Jet ◽  
Jet Lavage ◽  
Average Maximum ◽  
Cement Distribution ◽  
Vertebral Bodies

Abstract Background: Percutaneous vertebroplasty is the most common treatment for osteoporotic vertebral compression fracture. However, the morbidity of vertebroplasty-related complications, such as cement leakage, remains high. We tested a new technique of unilateral pulsed jet lavage and investigated its effect on the intravertebral pressure and bone cement distribution. Methods: Thirty lumbar vertebrae (L1-L5) from six cadaver spines were randomly allocated into two groups (with and without irrigation). Prior to vertebroplasty, pulsed jet lavage was performed through one side of the pedicle by using a novel cannula with two concentric conduits to remove the fat and bone marrow of the vertebral bodies in the group with irrigation. The control group was not irrigated. Then, standardized vertebroplasty was performed in the vertebral bodies in both groups. Changes in the intravertebral pressure during injection were recorded. Computed tomography (CT) was performed to observe the cement distribution and extravasations, and the cement mass volume (CMV) was calculated. Results: During cement injection, the average maximum intravertebral pressure of the unirrigated group was higher than that of the irrigated group (4.92kPa versus 2.22kPa, P<0.05). CT scans showed a more homogeneous cement distribution with less CMV (3832 mm 3 vs. 4344 mm 3 , P<0.05) and less leakage rate (6.7% vs. 46.7%, P<0.05) in the irrigated group than in the control group. Conclusions: Unilateral pulsed jet lavage can reduce intravertebral pressure and lower the incidence of cement leakage during vertebroplasty. An enhanced bone cement distribution can also be achieved through this lavage system.

scholarly journals Therapeutic effect of percutaneous kyphoplasty combined with anti-osteoporosis drug on postmenopausal women with osteoporotic vertebral compression fracture and analysis of postoperative bone cement leakage risk factors: a retrospective cohort study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Shuaihao Huang ◽  
Xiaowen Zhu ◽  
Dan Xiao ◽  
Jianxiong Zhuang ◽  
Guoyan Liang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Zoledronic Acid ◽  
Bone Cement ◽  
Postmenopausal Women ◽  
Therapeutic Effect ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Control Group ◽  
Height Ratio ◽  
Vertebral Height

Abstract Background The purpose of this study is to explore the therapeutic effect of percutaneous kyphoplasty (PKP) combined with anti-osteoporosis drug, zoledronic acid, on postmenopausal women with osteoporotic vertebral compression fracture (OVCF) and to perform an analysis of postoperative bone cement leakage risk factors. Methods A total of 112 OVCF patients, according to therapeutic regimens, were divided into control group (n = 52, treated with PKP) and observation group (n = 60, treated with PKP and zoledronic acid injection). Results Postoperative tumor necrosis factor-α and interleukin-6 levels were significantly decreased in the two groups, compared with those before treatment (both P < 0.05); bone mineral density (BMD), serum bone gla protein (BGP), and vertebral height ratio of injured vertebrae were significantly increased, and procollagen type I N-terminal propeptide (PINP), Cobb angle, visual analogue scale/score (VAS), and Oswestry disability index (ODI) were significantly decreased compared with those before treatment (all P < 0.05). There were significantly higher changes in difference value of BMD, PINP, BGP, vertebral height ratio of injured vertebrae, Cobb angle, VAS, and ODI levels and significantly better therapeutic effect in the observation group than those in the control group (all P < 0.05). Multivariate logistic regression analysis showed that the use of zoledronic acid, vertebral height ratio of injured vertebrae, and ODI were independent factors affecting the therapeutic effect, and that the dosage of bone cement, and peripheral vertebrae wall damage were independent risk factors causing postoperative bone cement leakage. There were no significant differences in postoperative bone cement leakage rate between the two groups. Conclusions Peripheral vertebrae wall damage and the dosage of bone cement are independent risk factors causing bone cement leakage in OVCF patients treated with PKP. PKP combined with zoledronic acid has an improvement effect on the condition of postmenopausal women with OVCF and reduces the inflammation and pain in patients, which is beneficial to clinical treatment.

Risk of cement leakage and pulmonary embolism by bone cement-augmented pedicle screw fixation of the thoracolumbar spine

2017 ◽  
Vol 17 (6) ◽  
pp. 837-844 ◽  
Author(s):  
Insa Janssen ◽  
Yu-Mi Ryang ◽  
Jens Gempt ◽  
Stefanie Bette ◽  
Julia Gerhardt ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Bone Cement ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Thoracolumbar Spine ◽  
Cement Leakage ◽  
Pedicle Screw Fixation

scholarly journals The Effect of Kryptonite Bone Cement combined with a Standard Kirschner Wire on Tibial Bone Fracture in Rats

2022 ◽  
Vol 9 (01) ◽  
pp. 5808-5913
Author(s):  
Ibrahim EKE ◽  
Mehmet Akif AKCAL ◽  
Yusuf IYETIN ◽  
OguzSükrü POYANLI
Keyword(s):  
Bone Cement ◽  
Bone Repair ◽  
Callus Formation ◽  
Statistical Significance ◽  
Kirschner Wire ◽  
Autogenous Bone ◽  
Control Group ◽  
Complete Fusion ◽  
Non Union ◽  
Experimental Group

Objective This study aims to observe whether Kryptonite Bone Cement combined with a standard Kirschner wire, instead of autogenous bone grafts, increases bone healing and mechanical strength in rats with tibia fractures. Methods The study included sixteen rats, which were divided into two groups as a control group (n=8) and an experimental group (n=8). After segmental fractures were made in both groups, intramedullary fixation of tibia procedures were conducted with the use of a Kirschner wire. No additional procedures were performed inthe control group, but Kryptonite Bone Cement was applied in the experimental group. The rats were evaluated clinically, radiologically and histologically4 times; immediately after the operation, and atthe 1st, 3rd, and 6thweeks following surgery. Results One rat from the experimental and one from the control group had both wound dehiscence and wound site infection. No recovery was observed in any rats either in the control or experimental group immediately after surgery. During week 1, callus formation was identified in 5 rats in the experimental group (p=0.0072), and during week 3, fracture lines disappeared in 4 rats in the experimental group (p=0.064); the differences between control and experimental groups were statistically significant. During week 6, no statistical significance was observed in radiological assessments for the control group and experimental group (p=0.71). The rate of non-union was higher in the control group (37.50%) than in the experimental one, while the rate of complete fusion was higher in the experimental group (87.50%) than that in the control group. Conclusion Osteoconductivity and ergonomic qualities of Kryptonite Bone Cement prove helpful in bone repair. Future studies to be conducted in a prospective and randomized manner will be effective on demonstrating the effectiveness of Kryptonite Bone Cement.

BIOMECHANICAL STUDY OF PEDICLE SCREW FIXATION STRENGTH: ASSOCIATION OF SCREW MALPOSITION AND SCREW INSERTION TORQUE

2019 ◽  
Vol 19 (02) ◽  
pp. 1940012
Author(s):  
TSUNG-TING TSAI ◽  
YU-HUNG CHEN ◽  
CHAO-YAUG LIAO ◽  
HSIN-TZU LIN ◽  
MU-YI LIU ◽  
...  
Keyword(s):  
Real Time ◽  
Pedicle Screw ◽  
Screw Fixation ◽  
Fixation Strength ◽  
Control Group ◽  
Insertion Torque ◽  
Pullout Strength ◽  
Screw Insertion ◽  
Medial Cortex ◽  
Screw Penetration

Pedicle screws have been widely used for the treatment of spinal diseases, but improper screw placement is not uncommon and may lead to neurovascular injuries and reduced screw fixation strength. This study aimed to investigate the feasibility of using real-time screw insertion torque monitoring to prevent screw penetration. Commercially available synthetic L4 vertebrae were divided in to seven test groups based on different screw placements. Screw insertion torque and maximal pullout strength were compared among groups. The results indicated that the insertion torque gradually increased when the screw tip was within vertebral cancellous bone without penetration. However, an instantaneous decrease of torque value was observed once the screw tip penetrated the cortex wall. When compared to the control group, higher pullout strength was found for the groups with medial cortex penetration. However, vertebrae with medial cortex penetration may lead to the concern of neurovascular damage. Meanwhile, lower pullout strength was found for the groups with lateral cortex penetration and end-plate penetration, which may lead to the concern of screw loosening. We concluded that pedicle screw penetration can be judged using real-time screw insertion torque monitoring during surgery, which may aid surgeons in avoiding neurovascular injury and reduction of screw fixation strength.

scholarly journals High-viscosity bone cement for vertebral compression fractures: a prospective study on intravertebral diffusion of bone cement

2020 ◽  
Author(s):  
meiyong wang ◽  
qunhua jin
Keyword(s):  
Diffusion Coefficient ◽  
Bone Cement ◽  
Statistical Significance ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Injection Time ◽  
Time Duration ◽  
Compression Fractures ◽  
Group B

Abstract Objective Bone cement leakage causes severe complication following percutaneous vertebroplasty. This study probed the diffusion and leakage status of bone cement injected within diverged time duration, so as to find the optimal injection time for bone cement. Methods A total of 70 patients with osteoporotic vertebral compression fractures with a symptom of low back pain, who underwent treatment at hospital were enrolled in this study. Patients were randomized into three groups: <180 s, 180-300, and >300 s of injection time duration from the beginning to the completion of the injection. The scenarios of vertebral bone cement leakage and diffusion were inspected using postoperative CT. Results The diffusion coefficient was higher in group A than in group B whereas it was higher in group B than in group C, but without statistical significance among the three groups. The leakage rate was without statistical significance among the three groups. The injection time of bone cement was negatively correlated with the diffusion coefficient, at the correlation coefficient of -0.253. Conclusions The diffusion coefficient of high-viscosity bone cement is likely negatively correlated with the injection time, and the leakage rate of high-viscosity bone cement probably does not reduce with the prolongation of injection time.

scholarly journals Treatment of Osteoporotic Vertebral Compression Fracture by Precise Injection and Staged Perfusion of Bone Cement Kyphoplasty: A Comparison Study

2021 ◽  
Author(s):  
Jian Huang ◽  
Jun Huang ◽  
Ming Chen ◽  
Zongbo Zhou ◽  
Zhifu Lu ◽  
...  
Keyword(s):  
Bone Cement ◽  
Vertebral Body ◽  
Compression Fracture ◽  
Cement Leakage ◽  
Osteoporotic Vertebral Compression Fracture ◽  
Control Group ◽  
The Third ◽  
Significant Difference ◽  
Experimental Group

Abstract Study design: Retrospective cohort study.Objective: To explore the clinical effect of precise injection and staged perfusion of bone cement kyphoplasty in the treatment of osteoporotic vertebral compression fracture.Methods: 110 patients treated with kyphoplasty from January 2020 to June 2021 were selected and divided into experimental group (n = 55) and control group (n = 55) according to different surgical methods. The experimental group was treated with precise injection and staged perfusion of bone cement kyphoplasty, while the control group was treated with traditional kyphoplasty. The operation time,intraoperative blood loss and amount of bone cement injection were recorded. The pain improvement was evaluated by VAS score. The operation effect were evaluated by anterior height of injured vertebral body, middle height of injured vertebral body, wedge angle of injured vertebral body and distribution grade of bone cement. The incidence of surgical complications was evaluated by the number of bone cement leakage.Results: There were no significant difference in the operation time, intraoperative blood loss and the amount of bone cement injection in two groups. There were no significant difference in VAS scores at 2h, 4h and 48h after operation between the two groups (P > 0.05); There were no significant difference in the ratio of anterior height of injured vertebral body between the two groups on the third day after operation and the last follow-up (P > 0.05); There were no significant difference in the ratio of middle height of injured vertebral body between the two groups on the third day after operation and the last follow-up (P > 0.05); There were no significant difference in wedge angle of injured vertebral body between the two groups at the third day after operation and the last follow-up (P > 0.05). There was significant difference in the distribution grade of bone cement between the two groups (P < 0.01); There was significant difference in the number of bone cement leakage between the two groups (P < 0.01), In cases of bone cement leakage, there were 1 case of type C, 1 case of type S in the experimental group, 7 cases of type C and 2 cases of type S in the control group.Conclusion: Precise injection and staged perfusion of bone cement kyphoplasty in the treatment of osteoporotic vertebral compression fracture can effectively reduce surgical complications and improve surgical efficacy.

scholarly journals High-viscosity bone cement for vertebral compression fractures: a prospective study on intravertebral diffusion of bone cement

2020 ◽  
Author(s):  
meiyong wang ◽  
qunhua jin
Keyword(s):  
Diffusion Coefficient ◽  
Bone Cement ◽  
Statistical Significance ◽  
Cement Leakage ◽  
High Viscosity ◽  
Vertebral Compression Fractures ◽  
Injection Time ◽  
Time Duration ◽  
Compression Fractures ◽  
Group B

Abstract Objective: Bone cement leakage causes severe complication following percutaneous vertebroplasty. This study probed the diffusion and leakage status of bone cement injected within diverged time duration, so as to find the optimal injection time for bone cement. Methods: A total of 70 patients with osteoporotic vertebral compression fractures with a symptom of low back pain, who underwent treatment at hospital were enrolled in this study. Patients were randomized into three groups: <180 s, 180-300, and >300 s of injection time duration from the beginning to the completion of the injection. The scenarios of vertebral bone cement leakage and diffusion were inspected using postoperative CT.Results: The diffusion coefficient was higher in group A than in group B whereas it was higher in group B than in group C, but without statistical significance among the three groups. The leakage rate was without statistical significance among the three groups. The injection time of bone cement was negatively correlated with the diffusion coefficient, at the correlation coefficient of -0.253. Conclusions: The diffusion coefficient of high-viscosity bone cement is likely negatively correlated with the injection time, and the leakage rate of high-viscosity bone cement probably does not reduce with the prolongation of injection time.

An Experimental Observation of Calcium Alginate Medical Film Prevents Bone Cement Leakage in PVP

2013 ◽  
Vol 631-632 ◽  
pp. 362-365
Author(s):  
Jian Xin Zhang ◽  
Yu Yang Lin ◽  
Yi Qiang Zhou
Keyword(s):  
Bone Cement ◽  
Calcium Alginate ◽  
Cement Leakage ◽  
Vertebral Compression Fractures ◽  
Control Group ◽  
Average Weight ◽  
Blank Group ◽  
Articular Process ◽  
Injection Dose ◽  
Experimental Group

Using calcium alginate medical film to explore the preventive measures of bone cement leakage in PVP.60 fresh vertebral bones were dissected from pigs(10 months old with average weight 152.5±7.5kg), and randomly divided into the blank group, the control group and the experimental group, 20 vertebral bones for a group. Eliminated the extra muscles and ligaments and the upper and lower endplates were completely retained. The models of vertebral compression fractures with fissures in front of vertebra were prepared by drilling two holes with a 3.2mm electric drill from lateral of the junction of the halfway point of parapophysis and the vertical of superior articular process to anterior vertebra along the direction of pedicles of vertebral archs by angle 10 and 15 degree and downward sloping 5 degree with the sagittal planes. Only bone cement was injected to the blank group, while the control group were injected with bone cement after injected medical fibrin glue. And the experimental group were injected with bone cement after injected sodium alginate glue and solidified by saturated calcium chloride. The injection dose of bone cement was recorded when bone cement leaked. The injection dose of bone cement in experimental group was significantly higher than the blank group and the control group when bone cement leaked (P<0.01).Calcium alginate medical film can effectively prevent the leakage of bone cement in PVP.

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