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Differences in endplate deformation of the adjacent and augmented vertebra following cement augmentation

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Abstract

Vertebral cement augmentation can restore the stiffness and strength of a fractured vertebra and relieve chronic pain. Previous finite element analysis, biomechanical tests and clinical studies have indirectly associated new adjacent vertebral fractures following augmentation to altered loading. The aim of this repeated measures in situ biomechanical study was to determine the changes in the adjacent and augmented endplate deformation following cement augmentation of human cadaveric functional spine units (FSU) using micro-computed tomography (micro-CT). The surrounding soft tissue and posterior elements of 22 cadaveric human FSU were removed. FSU were assigned to two groups, control (n = 8) (loaded on day 1 and day 2) and augmented (n = 14) (loaded on day 1, augmented 20% cement fill, and loaded on day 2). The augmented group was further subdivided into a prophylactic augmentation group (n = 9), and vertebrae which spontaneously fractured during loading on day 1 (n = 5). The FSU were axially loaded (200, 1,000, 1,500–2,000 N) within a custom made radiolucent, saline filled loading device. At each loading step, FSUs were scanned using the micro-CT. Endplate heights were determined using custom software. No significant increase in endplate deformation following cement augmentation was noted for the adjacent endplate (P > 0.05). The deformation of the augmented endplate was significantly reduced following cement augmentation for both the prophylactic and fracture group (P < 0.05, P < 0.01, respectively). Endplate deformation of the controls showed no statistically significant differences between loading on day 1 and day 2. A linear relationship was noted between the applied compressive load and endplate deflection (R 2 = 0.58). Evidence of significant endplate deformation differences between unaugmented and augmented FSU, while evident for the augmented endplate, was not present for the adjacent endplate. This non-invasive micro-CT method may also be useful to investigate endplate failure, and parameters that predict vertebral failure.

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Acknowledgments

Funding for this research was provided by AOSpine, Dübendorf, Switzerland (Grant # SRN 02/105). The authors wish to thank Josh MacNeil for his assistance with micro-CT data acquisition and analysis, Urs Rohrer, Erland Mülheim and Thomas Gerber for machining the loading device, and Mario Löffel for the use of the cement injection device and associated data acquisition equipment.

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Authors and Affiliations

  1. MEM Research Center, University of Bern, Stauffacherstrasse 78, 3014, Bern, Switzerland

    Paul A. Hulme & S. J. Ferguson

  2. Schulich School of Engineering, University of Calgary, Calgary, AB, Canada

    S. K. Boyd

  3. Department of Orthopaedic Surgery, Spine Service, Inselspital, University of Bern, Bern, Switzerland

    P. F. Heini

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  1. Paul A. Hulme
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  2. S. K. Boyd
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  3. P. F. Heini
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  4. S. J. Ferguson
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Correspondence to Paul A. Hulme.

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Hulme, P.A., Boyd, S.K., Heini, P.F. et al. Differences in endplate deformation of the adjacent and augmented vertebra following cement augmentation. Eur Spine J 18, 614–623 (2009). https://doi.org/10.1007/s00586-009-0910-3

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  • DOI: https://doi.org/10.1007/s00586-009-0910-3

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