Silk fibroin added to calcium phosphate cement to prevent severe cardiovascular complications.

Med Sci Monit. 2010 Aug 7;16(9):HY23-26

Authors: Ding T, Yang H, Maltenfort M, Xie R

As a bone cement in vertebroplasty and kyphoplasty, calcium phosphate cement (CPC) has several advantages over polymethylmethacrylate (PMMA) including biomcompatibility, biodegradability and osteoconductivity. However, its decay properties raise the risk of pulmonary embolism and consequent cardiovascular complications. Animal experiments have demonstrated that the disintegration of CPC forming more emboli, especially microemboli, causes more severe cardiovascular deterioration than PMMA. Current efforts focus on the incorporation of organic proteins or polymers into CPC to improve its stability in fluids, by enhancing the hydroxyapatite (HA) formation and reducing the fluid penetration. Silk fibroin (SF) can regular the mineralization process and bond with HA to form fibroin-HA nanocomposites with increased gelation properties. SF also has excellent biomechanical, biocompatible and biodegradable properties, and is convenient and inexpensive to produce. We hypothesize that silk fibroin can be used as an additive to improve the cohesion of CPC and decrease its risk of cardiovascular complications in its application in veterbroplasty/kyphoplasty.<br /> <br />

PMID: 20802422 [PubMed - in process]

A Clinical Comparative Study on Low Versus Medium Viscosity PolyMethylMetAcrylate Bone Cement in Percutaneous Vertebroplasty: Viscosity Associated With Cement Leakage.

Spine (Phila Pa 1976). 2010 Aug 26;

Authors: Nieuwenhuijse MJ, Muijs SP, van Erkel AR, Dijkstra SP

STUDY DESIGN.: Comparative, prospective follow-up study. OBJECTIVE.: Comparison of outcome between patients treated with Percutaneous VertebroPlasty (PVP) using low and medium viscosity PolyMethylMetAcrylate (PMMA) bone cement. SUMMARY OF BACKGROUND DATA.: Viscosity is the characterizing parameter of PMMA bone cement, currently the standard augmentation material in PVP, and influences interdigitation, cement distribution inside the vertebral body, injected volume and extravasation, thereby affecting the clinical outcome of PVP. Currently, low, medium, and high viscosity PMMA bone cements are used interchangeably. However, effect of viscosity on clinical outcome in patients with Osteoporotic Vertebral Compression Fractures (OVCFs) has not yet been explicit subject of investigation. METHODS.: Follow-up was conducted using a 0 to 10 Pain Intensity Numerical Rating Scale (PI-NRS) and the Short Form 36 (SF-36) Quality of Life questionnaire before PVP and at 7 days (PI-NRS only), 1, 3, and 12 months after PVP. Injected cement volume, degree of interdigitation, and cement leakage were analyzed on direct postoperative computed tomography scanning. At 6 and 52 weeks and at suspicion, patients were analyzed for new fractures. RESULTS.: A total of 30 consecutive patients received PVP using low viscosity PMMA bone cement (OsteoPal-V) for 62 OVCFs, followed by 34 patients who received PVP using medium viscosity PMMA bone cement (Disc-O-Tech) for 67 OVCFs. Results regarding PI-NRS and SF-36 were comparable between both groups. Postoperative comparison of injected cement volume, degree of interdigitation, proportion of bipedicular procedures, incidence of new vertebral fractures and complications revealed no differences between both groups. Viscosity was identified as a risk factor for the occurrence of cement leakage (yes/no, OR: 2.925, 95% confidence interval: [1.072-7.984], P = 0.036). CONCLUSION.: No major differences in clinical outcome after PVP in OVCFs using low and medium viscosity PMMA bone cement were found. Viscosity of PMMA bone cement was identified as an independent predictor of cement leakage.

PMID: 20802393 [PubMed - as supplied by publisher]

Vertebroplasty of the C2 Vertebral Body and Dens Using an Anterior Cervical Approach: Technical Case Report.

Neurosurgery. 2010 Aug 27;

Authors: Dorman JK

BACKGROUND AND IMPORTANCE:: This article is the first description of an anterior approach for a biopsy and vertebroplasty of the C2 body and dens. CLINICAL PRESENTATION:: A 52-year-old woman presented with a 9-month history of neck pain and a destructive lesion of the dens. The patient was treated with pain medication as well as steroid injections without relief of her pain. A biopsy and vertebroplasty of the C2 body and dens was performed using an anterior cervical approach. CONCLUSION:: This report describes the first vertebroplasty of C2 using an open anterior cervical approach.

PMID: 20802357 [PubMed - as supplied by publisher]