Can vertebroplasty restore normal load-bearing to fractured vertebrae?

STUDY DESIGN

Cadaver motion segments were used to evaluate the effects of vertebroplasty on spinal loading following vertebral fracture.

OBJECTIVES

To determine if vertebroplasty reverses fracture-induced changes in the distribution of compressive stress in cadaver motion segments.

SUMMARY OF BACKGROUND DATA

Vertebroplasty involves reinforcement of vertebrae by injection of cement and is now being used increasingly to treat osteoporotic vertebral fractures. However, its effects on spinal load-bearing are largely unknown. We hypothesize that vertebroplasty, following vertebral fracture, helps to equalize stress acting on the intervertebral disc and adjacent vertebral bodies.

METHODS

Nineteen cadaver thoracolumbar motion segments (age 64-90 years) were induced to fracture by compressive overload. Specimens were then subjected to vertebroplasty, and subsequently creep loaded for 1 hour at 1.5 kN. The compressive stress acting on the intervertebral disc was measured before and after fracture, after vertebroplasty, and after creep, by pulling a pressure transducer mounted in a 1.3-mm needle across the disc's midsagittal diameter. This information was then used to calculate neural arch load-bearing. At each time point, measurements were also made of compressive stiffness.

RESULTS

Vertebral fracture reduced motion segment compressive stiffness, decompressed the adjacent nucleus, increased stress concentrations in the posterior anulus, and increased neural arch load-bearing, all by a significant amount. Vertebroplasty partially, but significantly, reversed all of these fracture-induced changes.

CONCLUSIONS

Vertebroplasty reduces stress concentrations in the anulus and neural arch resulting in a more even distribution of compressive stress on the intervertebral disc and adjacent vertebral bodies.