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Biomechanical, histological and histomorphometric analyses of calcium phosphate cement compared to PMMA for vertebral augmentation in a validated animal model

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Abstract

Introduction

Calcium phosphate cements (biocements) are alternative materials for use in vertebral augmentation procedures, and are a potential solution to problems associated with polymethylmethacrylate (PMMA) cements. The aim of this study is to demonstrate the utility of percutaneously injected biocements compared with PMMA in a validated animal model of osteoporosis.

Materials and methods

Fortyseven augmentation procedures were performed on 11 osteoporotic sheep. 9 vertebrae were augmented with PMMA and 38 with a biocement. The animals were killed in four groups: at 7 days, 3 months, 6 months, and 1 year after intervention. Radiological study and TC of the pieces were obtained to evaluate for leakage, cement diffusion, and integration. In total, 26 biomechanic studies and 27 histomorphometry analyses were performed, included control vertebrae.

Results

In 20.9% of the vertebrae, the hole was empty at sacrifice. The pattern of fracture was heterogeneous, and cement augmentation did not increase vertebral strength or decrease vertebral stiffness compared to control vertebrae, with neither PMMA or biocement. The rate of remodeling of the biocement was not predictable. In the single majority, there is peripheral remodeling, staying the volume of injected biocement stable.

Conclusions

Even though this animal model may not be useful to analyze the biomechanical pattern of treated vertebrae, it demonstrates that the percutaneous use of biocements in vertebral augmentation techniques is not predictable. This is one reason not to recommend its use presently as a substitute for PMMA in vertebral reinforcement procedures.

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Authors and Affiliations

  1. Spine Service, Fundación Jiménez DÍaz, Av Reyes Católicos, 2, 28040, Madrid, Spain

    Luis Alvarez Galovich

  2. Neuroradiology Service, Fundación Jiménez DÍaz, Av Reyes Católicos, 2, 28040, Madrid, Spain

    Antonio Perez-Higueras

  3. Facultad de Veterinaria, Universidad de León, León, Spain

    Jose R. Altonaga & José Manuel Gonzalo Orden

  4. Laboratorio de Anatomía Patológica y Biología Molecular, Hospital del Mar, Barcelona, Spain

    Maria Lluisa Mariñoso Barba

  5. Departamento de Mecánica, E.T.S.Ingenieros Industriales, UNED, Madrid, Spain

    Maria Teresa Carrascal Morillo

Authors
  1. Luis Alvarez Galovich
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  2. Antonio Perez-Higueras
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  3. Jose R. Altonaga
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  4. José Manuel Gonzalo Orden
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  5. Maria Lluisa Mariñoso Barba
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Correspondence to Luis Alvarez Galovich.

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Galovich, L.A., Perez-Higueras, A., Altonaga, J.R. et al. Biomechanical, histological and histomorphometric analyses of calcium phosphate cement compared to PMMA for vertebral augmentation in a validated animal model. Eur Spine J 20 (Suppl 3), 376 (2011). https://doi.org/10.1007/s00586-011-1905-4

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