Zhou Xu, Qin Shenghua, Huang Chunhai, Li Feiwen, Liu Jin, Wu Ti, Zhang Mingzheng
Department of Orthopaedics, The First Affiliated Hospital of Jishou University, Jishou University, Jishou, China.
School of Medicine, Jishou University, Jishou, China.
Front Bioeng Biotechnol. 2025 Jul 8;13:1606709. doi: 10.3389/fbioe.2025.1606709. eCollection 2025.
Since the introduction of percutaneous cement discoplasty (PCD), numerous studies have confirmed its clinical efficacy in elderly patients. However, PCD is also associated with risks such as bone cement leakage and vertebral fractures. The purpose of this study was to present a biomechanical evaluation of two modified versions of PCD performed in combination with percutaneous vertebroplasty (PVP).
Data from a CT scan of a healthy male's lumbosacral region were used to establish finite element (FE) models of nonsurgical treatment, PCD, L4/5PCD + L4L5PVP (modified technique 1, where the bone cement in the L4/5 disc space does not connect with the L4 and L5 vertebrae) and PCIF (modified technique 2, where the bone cement in the L4/5 disc space connects with the L4 and L5 vertebrae). A compressive of preload 150 N and a moment of 10 N·m were applied to recreate flexion, extension, lateral bending, and axial rotation. The range of motion (ROM) of L3/4 and L4/5, maximum stress on the L3 inferior endplate, L4 inferior endplate and L5 superior endplate, stress on the annulus fibrosus of L4/5, and displacement of the bone cement were evaluated.
Both modified techniques outperformed the simple PCD technique in reducing stress on the endplate, stress on the annulus fibrosus, and displacement of the bone cement. The L4/5PCD + L4L5PVP technique was more advantageous in terms of reducing the incidence of postoperative complications. The addition of the PVP technique significantly enhanced spinal stability by increasing support to adjacent vertebrae, thereby reducing the risk of postoperative endplate fractures and bone cement leakage.
Modified PCD combined with PVP may be a safer and more effective option for treating degenerative disc diseases, providing important references for clinical treatment.
自经皮水泥椎间盘成形术（PCD）引入以来，大量研究证实了其在老年患者中的临床疗效。然而，PCD也存在诸如骨水泥渗漏和椎体骨折等风险。本研究的目的是对两种与经皮椎体成形术（PVP）联合应用的改良版PCD进行生物力学评估。
使用一名健康男性腰骶部区域的CT扫描数据，建立非手术治疗、PCD、L4/5PCD + L4L5PVP（改良技术1，其中L4/5椎间盘间隙中的骨水泥不与L4和L5椎体相连）和PCIF（改良技术2，其中L4/5椎间盘间隙中的骨水泥与L4和L5椎体相连）的有限元（FE）模型。施加150 N的预加载压缩力和10 N·m的力矩，以模拟前屈、后伸、侧屈和轴向旋转。评估L3/4和L4/5的活动范围（ROM）、L3下终板、L4下终板和L5上终板的最大应力、L4/5纤维环的应力以及骨水泥位移。
两种改良技术在降低终板应力、纤维环应力和骨水泥位移方面均优于单纯PCD技术。L4/5PCD + L4L5PVP技术在降低术后并发症发生率方面更具优势。PVP技术的加入通过增加对相邻椎体的支撑显著增强了脊柱稳定性，从而降低了术后终板骨折和骨水泥渗漏的风险。
改良PCD联合PVP可能是治疗椎间盘退变疾病更安全、有效的选择，为临床治疗提供重要参考。
