Trabecular Microstructure and Damage Affect Cement Leakage From The Basivertebral Foramen During Vertebral Augmentation

Shengyun Li, Chongyan Wang, Zhi Shan, Junhui Liu, Tianming Yu, Xuyang Zhang, Shunwu Fan, Blaine A Christiansen, Wenyuan Ding, Fengdong Zhao

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

STUDY DESIGN.: A prospective study on cadaver specimens. OBJECTIVE.: To explore why cement leakage from BF easily occurs during vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA.: Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown. METHODS.: 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of inter-trabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation and imaging-based diagnosis were used to evaluate cement leakage. RESULTS.: Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P?<?0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that inter-trabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously (Wang?C, et al. (2014) The spine journal: 14:1551–1558). CONCLUSION.: The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest inter-vertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury.Level of Evidence: 4

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Jan 16 2017

Fingerprint

Compression Fractures
X-Ray Microtomography
Spine
Body Regions
Wounds and Injuries
Cadaver
Prospective Studies
Cancellous Bone

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Trabecular Microstructure and Damage Affect Cement Leakage From The Basivertebral Foramen During Vertebral Augmentation. / Li, Shengyun; Wang, Chongyan; Shan, Zhi; Liu, Junhui; Yu, Tianming; Zhang, Xuyang; Fan, Shunwu; Christiansen, Blaine A; Ding, Wenyuan; Zhao, Fengdong.

In: Spine, 16.01.2017.

Research output: Contribution to journalArticle

Li, Shengyun ; Wang, Chongyan ; Shan, Zhi ; Liu, Junhui ; Yu, Tianming ; Zhang, Xuyang ; Fan, Shunwu ; Christiansen, Blaine A ; Ding, Wenyuan ; Zhao, Fengdong. / Trabecular Microstructure and Damage Affect Cement Leakage From The Basivertebral Foramen During Vertebral Augmentation. In: Spine. 2017.
@article{a6a371e74b33411296b981db790241df,
title = "Trabecular Microstructure and Damage Affect Cement Leakage From The Basivertebral Foramen During Vertebral Augmentation",
abstract = "STUDY DESIGN.: A prospective study on cadaver specimens. OBJECTIVE.: To explore why cement leakage from BF easily occurs during vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA.: Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown. METHODS.: 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of inter-trabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation and imaging-based diagnosis were used to evaluate cement leakage. RESULTS.: Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P?<?0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that inter-trabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously (Wang?C, et al. (2014) The spine journal: 14:1551–1558). CONCLUSION.: The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest inter-vertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury.Level of Evidence: 4",
author = "Shengyun Li and Chongyan Wang and Zhi Shan and Junhui Liu and Tianming Yu and Xuyang Zhang and Shunwu Fan and Christiansen, {Blaine A} and Wenyuan Ding and Fengdong Zhao",
year = "2017",
month = "1",
day = "16",
doi = "10.1097/BRS.0000000000002073",
language = "English (US)",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Trabecular Microstructure and Damage Affect Cement Leakage From The Basivertebral Foramen During Vertebral Augmentation

AU - Li, Shengyun

AU - Wang, Chongyan

AU - Shan, Zhi

AU - Liu, Junhui

AU - Yu, Tianming

AU - Zhang, Xuyang

AU - Fan, Shunwu

AU - Christiansen, Blaine A

AU - Ding, Wenyuan

AU - Zhao, Fengdong

PY - 2017/1/16

Y1 - 2017/1/16

N2 - STUDY DESIGN.: A prospective study on cadaver specimens. OBJECTIVE.: To explore why cement leakage from BF easily occurs during vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA.: Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown. METHODS.: 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of inter-trabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation and imaging-based diagnosis were used to evaluate cement leakage. RESULTS.: Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P?<?0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that inter-trabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously (Wang?C, et al. (2014) The spine journal: 14:1551–1558). CONCLUSION.: The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest inter-vertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury.Level of Evidence: 4

AB - STUDY DESIGN.: A prospective study on cadaver specimens. OBJECTIVE.: To explore why cement leakage from BF easily occurs during vertebral augmentation procedures. SUMMARY OF BACKGROUND DATA.: Type B (through BF, basivertebral foramen) cement leakage is the most common type after vertebral augmentation, but the mechanism of this is still controversial. The contribution of vertebral trabecular bone orientation and trabecular damage during compression fracture to cement leakage is still unknown. METHODS.: 12 fresh-frozen human lumbar spines (T12-L5) were collected and divided into 24 three-segment units. Mechanical testing was performed to simulate a compression fracture. MicroCT were performed on all segments before and after mechanical testing, and trabecular microstructure of the superior, middle (containing BF), and inferior 1/3 of each vertebral body was analyzed. The diameter variation of inter-trabecular space before and after compression fracture was used to quantify trabecular injury. After mechanical testing, vertebral augmentation and imaging-based diagnosis were used to evaluate cement leakage. RESULTS.: Trabecular bone microstructural parameters in middle region (containing BF) were lower than those of the superior or inferior regions (P?<?0.01). After compressive failure, 3D-reconstruction of the vertebral body by MicroCT demonstrated that inter-trabecular distance in the middle region was markedly increased. Type B cement leakage was the most common type after vertebral augmentation, as found previously (Wang?C, et al. (2014) The spine journal: 14:1551–1558). CONCLUSION.: The presence of the BF and the relative sparsity of trabecular bone make the middle region of the vertebral body the mechanically weakest region. Trabecular bone in middle region suffered the most severe damage during compressive failure of the vertebral body, which resulted in the greatest inter-vertebral spacing, and subsequently the highest percentage of type B cement leakage. These data suggest specific mechanisms by which cement may leak from the BF, and the contribution of trabecular microstructure and trabecular injury.Level of Evidence: 4

UR - http://www.scopus.com/inward/record.url?scp=85009758494&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85009758494&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000002073

DO - 10.1097/BRS.0000000000002073

M3 - Article

C2 - 28098744

AN - SCOPUS:85009758494

JO - Spine

JF - Spine

SN - 0362-2436

ER -