In silico investigation of vertebroplasty as a stand-alone treatment for vertebral burst fractures

• Finite element analyses to investigate the use of vertebroplasty as a treatment for vertebral burst fractures
• Vertebroplasty can be used to treat vertebral burst fractures to improve stiffness and stability
• The use of vertebroplasty as a treatment for vertebral burst fractures cause local overloading in the treated vertebra
• The use posterior instrumentation and vertebroplasty, or kyphoplasty is encouraged to promote stability of the treated VBFs

BackgroundThe use of percutaneous vertebroplasty as a stand-alone treatment for stable vertebral burst fractures has been investigated in vitro and in clinical studies. These studies present inconsistent results on the mechanical response of vertebroplasty-treated burst fractures. In addition, observations of the loss of sagittal alignment after vertebroplasty raise questions on the applicability of vertebroplasty for burst fractures. Therefore, the aim of this study was to investigate the mechanical stability of burst fractures after stand-alone treatment by vertebroplasty.MethodsFinite element simulations were performed with models generated from two laboratory-induced burst fractures in human thoracolumbar specimens. The burst fracture models were virtually injected with various cement volumes using a unipedicular or bipedicular approach. The models were subjected to four individual loads (compression, lateral bending, extension and torsion) and a multi-axial load case in the physiological range.FindingsAll treated burst fractures showed improvements in stiffness and a reduction in inter-fragmentary displacements, thus potentially providing a suitable mechanical environment for fracture healing. However, large volumes of the trabecular bone (< 43%), cement (< 53%) and bone–cement composite (< 58%) were predicted to experience strain levels exceeding the yield point. While damage was not specifically modeled, this implies a potential collapse of the treated vertebra due to local failure.InterpretationTo improve the primary stability and to prevent the collapse of treated burst fractures, the use of posterior instrumentation is suggested as an adjunct to vertebroplasty.