Morphological changes of injected calcium phosphat

Authors: D H Heo Y J Cho S H Sheen S U Kuh S M Cho S M Oh

Publish Date: 2009/03/20

Volume: 20, Issue: 12, Pages: 2063-2070

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Abstract

This study was undertaken to investigate the radiologic and clinical outcomes of vertebroplasty with calcium phosphate CaP cement in patients with osteoporotic vertebral compression fractures The morphological changes of injected CaP cement in osteoporotic compressed vertebral bodies were variable and unpredictable We suggest that the practice of vertebroplasty using CaP should be reconsideredRecently CaP an osteoconductive filler material has been used in the treatment of osteoporotic compression fractures However the clinical results of CaPcementaugmented vertebrae are still not well established The purpose of this study is to assess the clinical results of vertebroplasty with CaP by evaluating the morphological changes of CaP cement in compressed vertebral bodiesFourteen patients have been followed for more than 2 years after vertebroplasty The following parameters were reviewed age sex T score compliance with osteoporosis medications visual analog scale score compression ratio subsequent compression fractures and any morphological changes in the filler materialThe morphological changes of injected CaP included reabsorption condensation bone formation osteogenesis fracture of the CaP solid hump and heterotopic ossification Out of 14 patients 11 786 developed progression of the compression of the CaPaugmented vertebral bodies after vertebroplastyThe morphological changes of the injected CaP cement in the vertebral bodies were variable and unpredictable The compression of the CaPaugmented vertebrae progressed continuously for 2 years or more The findings of this study suggest that vertebroplasty using CaP cement should be reconsideredPercutaneous vertebroplasty PVP is a common and popular procedure in osteoporotic vertebral compression fractures 1 2 3 4 Traditionally polymethylmethacrylate PMMA cement has been used in vertebroplasty as a filler material However PMMA cement has several disadvantages such as the possibility of exothermal injury lack of osteoconductivity and the alteration of normal biomechanics 5 6 7 8 Therefore calcium phosphate CaP an osteoconductive filler material has been used in the treatment of osteoporotic compression fractures instead of PMMA 9 10 11 It has been reported that there are advantages to the use of calcium phosphate cement 12 13 14 15 CaP cement has osteoconductivity and might not alter the normal spinal biomechanics However the clinical results of CaPcementaugmented vertebrae are still not well established The fact that CaP has a weaker strength than PMMA may also be a disadvantage 16 The clinical and radiological results of vertebroplasty using CaP cement have rarely been reported and there are some controversies about the therapeutic validity of CaP in vertebroplasty 16 The authors analyzed the radiological and clinical results of vertebroplasty using CaP cement The purpose of this study is to assess the clinical validity of vertebroplasty with CaP by evaluating the morphological changes of the CaP cement in compressed vertebral bodiesThe authors performed 96 vertebroplasty or kyphoplasty procedures in osteoporotic vertebral compression fracture patients from December 2005 to November 2006 Among them 45 levels of 44 patients were treated by vertebroplasty with CaP cement We included only the patients who were followed for more than 2 years A total of 14 levels in 14 patients were enrolled in our study All of the patients had a singlelevel osteoporotic vertebral compression fracture The patients with multilevel vertebral compression fractures were excluded from this study The patients who were treated by kyphoplasty or who had pathologic vertebral compression fractures from spinal metastatic cancer osteolytic bone tumors and hemangioma were excluded from this study Also patients who had a secondary osteoporosis were excluded All of the patients participated in followup care via an outpatient clinic once a month for 2 months after the PVP for the regular administration of osteoporosis medications and postoperative radiological evaluations

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