Low Volume Vertebral Augmentation with Cortoss® Cement for Treatment of High Degree Vertebral Compression Fractures and Vertebra Plana
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This is a retrospective analysis of a consecutive series of patients undergoing vertebroplasty and vertebral augmentation in an outpatient setting for high degree osteoporotic vertebral fractures or vertebra plana using consistently low volumes (less than 3 cc) of Cortoss® cement, rather than polymethylmethacrylate (PMMA). The results in these patients demonstrate that it is both technically feasible to do vertebroplasty on these patients and using a low volume hydrophilic silica-based cement is effective in providing diffuse vertebral body fill with minimal complications. There was no increased risk of complications, such as cement leakage, displacement of bone fragments, or progression of the angulation. Specifically, with over a 24-month follow-up, the preoperative collapse or angulation did not worsen and none of the patients developed adjacent level fractures or required further surgery at the involved vertebral level.Keywords:
Vertebra
Vertebral Compression Fracture
Bone cement
Objective To observe the results of the metastatic tumor of spinal vertebra treated with replacement of the artificial vertebral body. Method An adjustable hollow artificial vertebral body was made from titanium for medical use. 12 patients with the metastatic tumors of the vertebral body were treated with this technique. The relief of the pain and the function of spinal cord were monitored. The stability of the operated segments was observed.Results The patients were followed up from 6 to 34 months with an average of 11.5 months. The neurological functions were improved markedly, especially for the pain relieving. The implants were stable and the reconstruction of the segment height was observed on the X-ray films. Conclusions The height of anterior column and the stability of the operated segments can be reconstructed by implanting the adjustable hollow artificial vertebral body. This technique may be an alternative method for the treatment of the metastasis in spinal vertebral body.
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Acrylic bone cement is weakened by its porosity, which promotes the formation of microcracks, which contribute to major crack propagation and ultimately failure of the cement mantle. Bone cement mixing techniques play a significant role in determining the quality of bone cement produced. A high degree of porosity is found to exist in cement that is inadequately mixed. Current commercial bone cement mixing systems allow for the preparation of the bone cement under the application of a vacuum in a closed, sealed chamber by means of a repeatable mixing action. These mixing systems are perceived to be repeatable and reliable by orthopaedic community. In this paper, the quality of bone cement mixed using an operator independent bone cement mixing system was compared with that of cement prepared using commercially available devices. The results of the investigation highlighted that cement prepared using the automated, repeatable mixing regime that is operator independent demonstrated consistently better physical and mechanical properties in comparison with cement mixed using proprietary cement mixing devices. Furthermore, Design of Experiments software established the optimal factors that influenced the physical and mechanical properties of PMMA bone cement.
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Abstract In this paper, we reported the results of our efforts in developing DCPA/nanosilica composite orthopedic cement. It is motivated by the significances of DCPA and silicon in bone physiological activities. More specifically, this paper examined the effects of various experimental parameters on the properties of such composite cements. In this work, DCPA cement powders were synthesized using a microwave synthesis technique. Mixing colloidal nanosilica directly with synthesized DCPA cement powders can significantly reduce the washout resistance of DCPA cement. In contrast, a DCPA–nanosilica cement powder prepared by reacting Ca(OH) 2 , H 3 PO 4 and nanosilica together showed good washout resistance. The incorporation of nanosilica in DCPA can improve compressive strength, accelerate cement solidification, and intensify surface bioactivity. In addition, it was observed that by controlling the content of NaHCO 3 during cement preparation, the resulting composite cement properties could be modified. Allowing for the development of different setting times, mechanical performance and crystal features. It is suggested that DCPA–nanosilica composite cement can be a potential candidate for bone healing applications. © 2014 Wiley Periodicals, Inc. J Biomed Mater Res Part B, 102B: 1620–1626, 2014.
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The development of bone cement has experienced several stages, from polymethyl methacrylate(PMMA) bone cement, calcium phosphate cement(CPC) to glassbased bioactive bone cement(GBC). In this period, the mechanical and bioactive properties of bone cement was improved and its application was developed. In this article the latest research in bone cement, particularly, glassbased bone cement is introduced. The factors that affected the property is discussed and the possible future advances in this field is pointed out.
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A VARIETY of disorders can produce increased radiodensity, or sclerosis, of one or more vertebral bodies. Such sclerosis can involve (1) the entire vertebral body in a uniform fashion, (2) the superior or inferior surface, or both, (3) the vertebral margins, or (4) the interior of the bone. In each instance, the resulting radiological image is distinctive and frequently allows a precise diagnosis to be offered. This communication emphasizes the radiological and gross pathological features of common disorders leading to sclerosis of the vertebral body.
Uniform Sclerosis of Vertebral Body: The 'Ivory' Vertebra
Uniformly distributed sclerosis of an entire vertebral body is termed the "ivory" vertebra1(Fig 1). The increase in radiodensity is commonly dramatic and may involve a single vertebral body or multiple vertebral bodies. In some instances, the adjacent posterior elements of the vertebra, including the pedicles, laminae, and transverse and spinous processes, are also affected. TheVertebra
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Vertebral compression fractures are treated surgically for approximately 25 years. In percutaneous cement augmentation techniques bone cement is applied to a fractured vertebra under fluoroscopic evidence to stabilize the bone fragments. Complications due to leakage of the low viscosity bone cement are reported in 5 to 15% of all routine cases. During the intraoperative application of bone cement surgeons rely on visiohaptic feedback and hence need to be familiar with the cement's rheology properties. Therefore, training is necessary. A hybrid simulator for cement augmentation training was developed but the usage of expensive real cement limits its purpose as a training modality. Twentythree inexpensive bone substitutes were developed and tested with the objective to mimic real bone cement. Cement application measurements were conducted and a mathematical model of the measurement setup was created. Compared with real bone cement, a cement substitute based on Technovit 3040 in combination with radical catchers and additional additives was identified as an appropriate substitute for cement augmentation training.
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Purpose of the Study This study aims at investigating the effect of application time of bone cement on the cement-bone interface strength in two types of commercially available bone cements, Cement-A and Cement-B. Materials and methods Cement-A and Cement-B were applied to cancellous bone specimens at two different times; 2 and 4 minutes (min). The bone specimens were formulated from bovine bone. Specimens were loaded to failure and the force at which the cement-bone interface failed was recorded. The shear strength of the cement-bone interface was calculated by dividing the force at failure by the cross-sectional surface area of the cement-bone interface. Results The mean (± standard deviation) and median (inter-quartile range) shear strength of the cement-bone interface was 2.79 ± 1.29 MPa and 2.29 (2.34) MPa for Cement-A applied at 2 min; 1.35 ± 0.89 MPa and 1.35 (1.74) MPa for Cement-A applied at 4 min; 2.93 ± 1.21 MPa and 3.01 (2.61) MPa for Cement-B applied at 2 min; and 3.00 ± 1.11 MPa and 2.92 (1.61) MPa for Cement-B applied at 4 min. Compared to all other groups, the cement-bone interface strength was significantly lower when Cement-A was applied to the bone specimens at 4 min (p Conclusions Under these testing conditions, the cement-bone interface strength did not seem to be affected by the time of application of Cement-B to bone. However, it was significantly lower when Cement-A was applied to bone at 4 min.
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We developed a prepacked mixing system for the preparation of bone cement. The system is based on mixing and collection of bone cement under a vacuum and serves as both the storage and mixing device for the cement components, thereby minimizing the exposure of the operating staff to the monomer and the risk for contamination of the cement during preparation. We evaluated the system using Palacos® R and Simplex® P. The cement produced was compared with cement obtained from a commercially available mixing system. Temperature evolution during curing, handling characteristics, density, and porosity of the cement obtained were analyzed. The results showed that the experimental system produces cement with physical properties (i.e., setting times and temperature, porosity, and density) equal to or better than those obtained with commercially available systems. Reducing the amount of monomer in the experimental system led to a reduction of the curing temperature without compromising the physical properties of the cements. © 1997 John Wiley & Sons, Inc. J Biomed Mater Res (Appl Biomater) 38: 135–142, 1997
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In literature reports on strontia-containing PMMA bone cements, the strontia was combined with another material, micron-sized particles were used and in vitro fatigue data are sparse. The present report is on the in vitro characterisation of a strontia-containing PMMA bone cement in which nano-sized strontia particles that were not combined with any other material were used (NANOSRO cement). Compared to the control cement (a commercially-based cement brand with the same composition as that of NANOSRO cement, except that the radiopacifier was BaSO4), NANOSRO cement had significantly higher radiopacity, lower polymerisation rate at 37°C and longer fatigue life. With regard to setting time, maximum exotherm temperature and compressive strength, the values for both cements were within the limits stipulated in the relevant testing standards. These results suggest that NANOSRO cement has promise for use in anchoring total joint replacements and, therefore, should be studied further.
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Abstract A ZnO containing nano‐hydroxyapatite/chitosan (n‐HA/CS) cement was developed and its bone formation ability was investigated in vitro and in vivo . The physico‐chemical properties of the cement were determined in terms of pH variation during and after setting, injectability and wettability. The results indicated that, the pH varied from 7.04 to 7.12 throughout the soaking of the cement in distilled water. The injectability was excellent during the first 4 min, but the cement became less injectable or even not injectable at all after 7 min setting. The static contact angle of the cement against water was 53.5 ± 2.7°. The results of immersion tests in simulated body fluid (SBF) indicated that the cement exhibited excellent bone‐like apatite forming ability. In vivo studies, involving the installation of the cement of tibial‐bone defects in rabbit tibia revealed an inflammatory response around the cement at 3 days of implantation. After 4 weeks, the inflammation began to disappear and the cement had bound to the surrounding host bone. Radiological examination also confirmed that the ZnO containing n‐HA/CS cement significantly induced new bone formation. These results suggest that the ZnO containing n‐HA/CS cement may be beneficial to enhance bone regeneration in osseous defect sites. © 2009 Wiley Periodicals, Inc. J Biomed Mater Res 2010
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