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Biomechanical evaluation of combined short segment fixation and augmentation of incomplete osteoporotic burst fractures

Background: Treating traumatic fractures in osteoporosis is challenging. Multiple clinical treatment options are found in literature. Augmentation techniques are promising to reduce treatment-related morbidity. In recent years, there have been an increasing number of reports about extended indication for augmentation techniques. However, biomechanical evaluations of these techniques are limited.
Methods: Nine thoracolumbar osteoporotic spinal samples (4 FSU) were harvested from postmortem donors and immediately frozen. Biomechanical testing was performed by a robotic-based spine tester. Standardized incomplete burst fractures were created by a combination of osteotomy-like weakening and high velocity compression using a hydraulic material testing apparatus. Biomechanical measurements were performed on specimens in the following conditions: 1) intact, 2) fractured, 3) bisegmental instrumented, 4) bisegmental instrumented with vertebroplasty (hybrid augmentation, HA) and 5) stand-alone vertebroplasty (VP). The range of motion (RoM), neutral zone (NZ), elastic zone (EZ) and stiffness parameters were determined. Statistical evaluation was performed using Wilcoxon signed-rank test for paired samples (p = 0.05). Results: Significant increases in RoM and in the NZ and EZ (p < 0.005) were observed after fracture production. The RoM was decreased significantly by applying the dorsal bisegmental instrumentation to the fractured specimens (p < 0.005). VP reduced fractured RoM in flexion but was still increased significantly (p < 0.05) above intact kinematic values. NZ stiffness (p < 0.05) and EZ stiffness (p < 0.01) was increased by VP but remained lower than prefracture values. The combination of short segment instrumentation and vertebroplasty (HA) showed no significant changes in RoM and stiffness in NZ in comparison to the instrumented group, except for significant increase of EZ stiffness in flexion (p < 0.05). Conclusions: Stand-alone vertebroplasty (VP) showed some degree of support of the anterior column but was accompanied by persistent traumatic instability. Therefore, we would advocate against using VP as a stand-alone procedure in traumatic fractures. HA did not increase primary stability of short segment instrumentation. Some additional support of anterior column and changes of kinematic values of the EZ may lead one to suppose that additive augmentation may reduce the load of dorsal implants and possibly reduce the risk of implant failure.

Titel: Biomechanical evaluation of combined short segment fixation and augmentation of incomplete osteoporotic burst fractures
Verfasser: Hartensuer, René GND
Gehweiler, Dominic Andreas GND
Schulze, Martin
Matuszewski, Lars GND
Raschke, Michael J.
Organisation: FB 05: Medizinische Fakultät
Dokumenttyp: Artikel
Medientyp: Text
Erscheinungsdatum: 21.12.2013
Publikation in MIAMI: 26.02.2014
Datum der letzten Änderung: 16.04.2019
Quelle: BMC Musculoskeletal Disorders 14 (2013) 360
Schlagwörter: Biomechanics; Osteoporosis; Trauma; Vertebroplasty; Instrumentation; Burst fracture; Spine
Fachgebiete: Medizin und Gesundheit
Lizenz: CC BY 2.0
Sprache: Englisch
Anmerkungen: Finanziert durch den Open-Access-Publikationsfonds 2013/2014 der Deutschen Forschungsgemeinschaft (DFG) und der Westfälischen Wilhelms-Universität Münster (WWU Münster).
Format: PDF-Dokument
URN: urn:nbn:de:hbz:6-74309586630
DOI: 10.1186/1471-2474-14-360