Abstract
Summary
This study assessed whether vertebroplasty increases trabecular bone microfractures in adjacent vertebrae of elderly female cadavers. Results indicated microfractures were almost two times greater in superior adjacent vertebrae for vertebroplasty treated spines compared to non-treated controls. This finding may aid in developing improved treatments for osteoporotic women with vertebral fractures.
Introduction
Although vertebroplasty may stabilize compression fractures and reduce pain, subsequent vertebral fractures occur in approximately 25 % of patients, reducing the overall safety of this procedure. This is particularly a concern in vertebrae surrounding the treated level where bone cement may cause abnormal transfer of forces to adjacent spinal structures. Therefore, the objective of this study was to quantify the effects of vertebroplasty on local trabecular bone damage in adjacent vertebrae.
Methods
Five level motion segments (T11-L3) from osteopenic/osteoporotic female cadaver spines (T-score −2.9 ± 1.0) were assigned into either vertebroplasty or control (no vertebroplasty) groups (n = 10/group) such that T-score, trabecular microarchitecture, and age were similar between groups. Compression fractures were created in the L 1 vertebra of all specimens and PMMA bone cement was injected into the fractured vertebra of vertebroplasty specimens. All spine segments were subjected to cyclic axial compression (685–1370 N) for 115,000 cycles. Post-testing, trabecular cubes were cut from adjacent (T12 and L2) vertebral bodies and histologically processed. Trabecular microfractures were identified and normalized by bone area in each section.
Results
There were significantly more trabecular microfractures (p < 0.001) in superior adjacent vertebral bodies of the vertebroplasty group (0.091 ± 0.025 microfractures/mm2) when compared to the control group (0.049 ± 0.018 microfractures/mm2). However, there was no difference in trabecular microfractures (p = 0.835) between vertebroplasty (0.045 ± 0.022 microfractures/mm2) and control groups (0.035 ± 0.013 microfractures/mm2) for inferior adjacent vertebral bodies.
Conclusions
Vertebroplasty specifically impacts the superior adjacent vertebrae of elderly female spines resulting in almost two times more trabecular microfractures when compared to non-treated controls.
References
Riggs BL, Melton LJ 3rd (1995) The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 17:505S–511S
Chosa K, Naito A, Awai K (2011) Newly developed compression fractures after percutaneous vertebroplasty: comparison with conservative treatment. Jpn J Radiol 29:335–341
Baroud G, Nemes J, Heini P, Steffen T (2003) Load shift of the intervertebral disc after a vertebroplasty: a finite-element study. Eur Spine J 12:421–426
Polikeit A, Nolte LP, Ferguson SJ (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine 28:991–996
Nagaraja S, Awada HK, Dreher ML, Bouck J, Gupta S (2015) Effects of vertebroplasty on endplate subsidence in elderly female spines. J Neurosurg Spine 22(3):273–82
Trout AT, Kallmes DF, Layton KF, Thielen KR, Hentz JG (2006) Vertebral endplate fractures: an indicator of the abnormal forces generated in the spine after vertebroplasty. J Bone Miner Res 21:1797–1802
Eswaran SK, Gupta A, Adams MF, Keaveny TM (2006) Cortical and trabecular load sharing in the human vertebral body. J Bone Miner Res 21:307–314
Fazzalari NL, Kuliwaba JS, Forwood MR (2002) Cancellous bone microdamage in the proximal femur: influence of age and osteoarthritis on damage morphology and regional distribution. Bone 31:697–702
Green JO, Nagaraja S, Diab T, Vidakovic B, Guldberg RE (2011) Age-related changes in human trabecular bone: relationship between microstructural stress and strain and damage morphology. J Biomech 44:2279–2285
Samelson EJ, Hannan MT, Zhang Y, Genant HK, Felson DT, Kiel DP (2006) Incidence and risk factors for vertebral fracture in women and men: 25-year follow-up results from the population-based Framingham study. J Bone Miner Res 21:1207–1214
Nagaraja S, Awada HK, Dreher ML, Gupta S, Miller SW (2013) Vertebroplasty increases compression of adjacent IVDs and vertebrae in osteoporotic spines. Spine J 13:1872–1880
Kim SH, Kang HS, Choi JA, Ahn JM (2004) Risk factors of new compression fractures in adjacent vertebrae after percutaneous vertebroplasty. Acta Radiol 45:440–445
Molloy S, Mathis JM, Belkoff SM (2003) The effect of vertebral body percentage fill on mechanical behavior during percutaneous vertebroplasty. Spine 28:1549–1554
Oakland RJ, Furtado NR, Wilcox RK, Timothy J, Hall RM (2009) Preliminary biomechanical evaluation of prophylactic vertebral reinforcement adjacent to vertebroplasty under cyclic loading. Spine J 9:174–181
Cappozzo A (1984) Compressive loads in the lumbar vertebral column during normal level walking. J Orthop Res: Off Publ Orthop Res Soc 1:292–301
Nagaraja S, Ball MD, Guldberg RE (2007) Time-dependent damage accumulation under stress relaxation testing of bovine trabecular bone. Int J Fatigue 29:1034–1038
Nagaraja S, Skrinjar O, Guldberg RE (2011) Spatial correlations of trabecular bone microdamage with local stresses and strains using rigid image registration. Journal of Biomechanical Engineering-Transactions of the Asme 133:
Arthur Moore TL, Gibson LJ (2002) Microdamage accumulation in bovine trabecular bone in uniaxial compression. J Biomech Eng 124:63–71
Wang JL, Chiang CK, Kuo YW, Chou WK, Yang BD (2012) Mechanism of fractures of adjacent and augmented vertebrae following simulated vertebroplasty. J Biomech 45:1372–1378
Mazzantini M, Carpeggiani P, d'Ascanio A, Bombardieri S, Di Munno O (2011) Long-term prospective study of osteoporotic patients treated with percutaneous vertebroplasty after fragility fractures. Osteoporos Int 22:1599–1607
Mulder JE, Michaeli D, Flaster ER, Siris E (2000) Comparison of bone mineral density of the phalanges, lumbar spine, hip, and forearm for assessment of osteoporosis in postmenopausal women. J Clin Densitom 3:373–381
Acknowledgments
This research study was funded by a grant through the FDA’s Office of Women’s Health. The authors would like to thank Ronald Wade and Anthony Pleasant for cadaver procurement, and Steven Kaplan and Sarah Schmiedel for histology of trabecular cores.
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
Srinidhi Nagaraja hold a PhD. U.S. Food and Drug Administration
Hassan K. Awada hold a BS. U.S. Food and Drug Administration
Maureen L. Dreher hold a PhD. U.S. Food and Drug Administration
Rights and permissions
About this article
Cite this article
Nagaraja, S., Awada, H.K. & Dreher, M.L. Vertebroplasty increases trabecular microfractures in elderly female cadaver spines. Osteoporos Int 26, 2029–2034 (2015). https://doi.org/10.1007/s00198-015-3105-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00198-015-3105-2