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Vertebral balloon kyphoplasty versus vertebral body stenting in non-osteoporotic vertebral compression fractures at the thoracolumbar junction: a comparative radiological study and finite element analysis (BONEXP study)

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Abstract

Objective

To compare radiologically balloon kyphoplasty (BKP) and vertebral compression fracture (VCF) expansion and corroborate with a finite element (FE) analysis. The principle of BKP is to stabilize VCF by restoring vertebral body anatomy using bone expansion and cement filling. More recently, vertebral body stenting (VBS) has been developed to reduce the loss of vertebral height observed after balloon deflation.

Methods

A retrospective, monocentric and continuous study of 60 non-osteoporotic fractures of the thoracolumbar junction treated by vertebral bone expansion was carried out over three years. The main endpoint was radiological correction of vertebral kyphosis (VK) at 3 months. The other studied parameters were vertebral height, index of Farcy, index of Beck, cement leakages and their location.

A FE model was developed to analyze effects linked to the stent during cement injection, specifically throughout the risk of cement leakage evaluation.

Results

After three months, average reduction of VK was 4.73° ± 4.8° after BKP, and 4.63° ± 2.7° after VBS. There was no difference between the two techniques, but cement leakage was significantly greater with BKP (41.7%) than with VBS (4.2%). FE analysis showed substantial changes of the cement flow orientation in the presence of a stent.

Conclusion

BKP and VBS offer comparable expansion with no added value of VBS in non-osteoporotic VCF reduction. VBS technique appears to prevent cement leakage due to its mesh architecture hindering the leaking process. In counterpart, such balloon expansion is likely to require higher pressure to deploy the stent. This could be an important parameter to take into account in young patients with high bone density.

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Acknowledgements

The authors wish to thank Jeffrey Arsham, an American translator, for rereading and correction of the original English-language manuscript.

Funding

No funding was received for this study.

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Author notes

  1. Tanguy Vendeuvre and Paul Brossard have contributed equally to this work.

Authors and Affiliations

  1. Department of Spine, Neuromodulation and Rehabilitation, Poitiers University Hospital, Poitiers, France

    Tanguy Vendeuvre, Paul Brossard, Jean-Baptiste Pic, Pierre Pries, Simon Teyssédou & Philippe Rigoard

  2. PRISMATICS Lab, Poitiers University Hospital, Poitiers, France

    Tanguy Vendeuvre, Paul Brossard, Jean-Baptiste Pic, Maxime Billot & Philippe Rigoard

  3. Department of Orthopaedic Surgery and Traumatology, Poitiers University Hospital, Poitiers, France

    Tanguy Vendeuvre, Paul Brossard, Jean-Baptiste Pic, Louis-Etienne Gayet & Pierre Pries

  4. Institut Pprime UPR 3346 CNRS, Université de Poitiers – ISAE-ENSMA, Bd Marie et Pierre Curie, Futuroscope, 86000, Poitiers, France

    Tanguy Vendeuvre, Arnaud Germaneau & Philippe Rigoard

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  1. Tanguy Vendeuvre
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Correspondence to Arnaud Germaneau.

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Conflict of interest

T. Vendeuvre is consultant for companies Medtronic (Dublin, Ireland), Safe Orthopaedics (Paris, France), Spineart (Geneva, Switzerland), and he has received previously research grants from company Medtronic for other research works. P. Rigoard is consultant for companies Medtronic (Dublin, Ireland), Boston Scientific (Malborough, MA, USA), ABBOTT (Chicago, IL, U.S.), and he has received previously research grants from company Medtronic for other research works. P. Pries is consultant for company Spineart (Geneva, Switzerland). S. Teyssédou is consultant for companies Medtronic (Dublin, Ireland) and Safe Orthopaedics (Paris, France). A. Germaneau is consultant for company Medtronic (Dublin, Ireland).

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Vendeuvre, T., Brossard, P., Pic, JB. et al. Vertebral balloon kyphoplasty versus vertebral body stenting in non-osteoporotic vertebral compression fractures at the thoracolumbar junction: a comparative radiological study and finite element analysis (BONEXP study). Eur Spine J 30, 3089–3098 (2021). https://doi.org/10.1007/s00586-021-06785-5

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  • DOI: https://doi.org/10.1007/s00586-021-06785-5

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