Tanguy Vendeuvre1,2,3,4, Paul Brossard1,2,3, Jean-Baptiste Pic1,2,3, Maxime Billot2, Louis-Etienne Gayet3, Pierre Pries1,3, Simon Teyssédou1, Arnaud Germaneau5, Philippe Rigoard1,2,4. 1. Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France. 2. PRISMATICS Lab, Poitiers University Hospital, Poitiers, France. 3. Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France. 4. Institut Pprime UPR 3346 CNRS, Université de Poitiers - ISAE-ENSMA, Bd Marie et Pierre Curie, Futuroscope, 86000, Poitiers, France. 5. Institut Pprime UPR 3346 CNRS, Université de Poitiers - ISAE-ENSMA, Bd Marie et Pierre Curie, Futuroscope, 86000, Poitiers, France. arnaud.germaneau@univ-poitiers.fr.
Abstract
OBJECTIVE: To compare radiologically balloon kyphoplasty (BKP) and vertebral compression fracture (VCF) expansion and corroborate with a finite element (FE) analysis. The principle of BKP is to stabilize VCF by restoring vertebral body anatomy using bone expansion and cement filling. More recently, vertebral body stenting (VBS) has been developed to reduce the loss of vertebral height observed after balloon deflation. METHODS: A retrospective, monocentric and continuous study of 60 non-osteoporotic fractures of the thoracolumbar junction treated by vertebral bone expansion was carried out over three years. The main endpoint was radiological correction of vertebral kyphosis (VK) at 3 months. The other studied parameters were vertebral height, index of Farcy, index of Beck, cement leakages and their location. A FE model was developed to analyze effects linked to the stent during cement injection, specifically throughout the risk of cement leakage evaluation. RESULTS: After three months, average reduction of VK was 4.73° ± 4.8° after BKP, and 4.63° ± 2.7° after VBS. There was no difference between the two techniques, but cement leakage was significantly greater with BKP (41.7%) than with VBS (4.2%). FE analysis showed substantial changes of the cement flow orientation in the presence of a stent. CONCLUSION: BKP and VBS offer comparable expansion with no added value of VBS in non-osteoporotic VCF reduction. VBS technique appears to prevent cement leakage due to its mesh architecture hindering the leaking process. In counterpart, such balloon expansion is likely to require higher pressure to deploy the stent. This could be an important parameter to take into account in young patients with high bone density.
OBJECTIVE: To compare radiologically balloon kyphoplasty (BKP) and vertebral compression fracture (VCF) expansion and corroborate with a finite element (FE) analysis. The principle of BKP is to stabilize VCF by restoring vertebral body anatomy using bone expansion and cement filling. More recently, vertebral body stenting (VBS) has been developed to reduce the loss of vertebral height observed after balloon deflation. METHODS: A retrospective, monocentric and continuous study of 60 non-osteoporotic fractures of the thoracolumbar junction treated by vertebral bone expansion was carried out over three years. The main endpoint was radiological correction of vertebral kyphosis (VK) at 3 months. The other studied parameters were vertebral height, index of Farcy, index of Beck, cement leakages and their location. A FE model was developed to analyze effects linked to the stent during cement injection, specifically throughout the risk of cement leakage evaluation. RESULTS: After three months, average reduction of VK was 4.73° ± 4.8° after BKP, and 4.63° ± 2.7° after VBS. There was no difference between the two techniques, but cement leakage was significantly greater with BKP (41.7%) than with VBS (4.2%). FE analysis showed substantial changes of the cement flow orientation in the presence of a stent. CONCLUSION:BKP and VBS offer comparable expansion with no added value of VBS in non-osteoporotic VCF reduction. VBS technique appears to prevent cement leakage due to its mesh architecture hindering the leaking process. In counterpart, such balloon expansion is likely to require higher pressure to deploy the stent. This could be an important parameter to take into account in young patients with high bone density.
Entities:
Keywords:
Balloon kyphoplasty; Bone expansion; Minimally invasive technique; Thoracolumbar spine; Vertebral body stenting; Vertebral compression fracture
Authors: L Garnier; J Tonetti; A Bodin; H Vouaillat; P Merloz; R Assaker; C Court Journal: Orthop Traumatol Surg Res Date: 2012-08-28 Impact factor: 2.256