European Spine Journal

, Volume 16, Issue 5, pp 601–610

Prospective study of standalone balloon kyphoplasty with calcium phosphate cement augmentation in traumatic fractures

  • Gianluca Maestretti
  • Claus Cremer
  • Philippe Otten
  • Roland Peter Jakob
Original Article

Abstract

Prospective consecutive series cases study to investigate the clinical and radiological results of standalone balloon kyphoplasty and cement augmentation with calcium phosphate in traumatic fractures. Independent observer evaluation of radiological and computer tomography results, visual analogue scale (VAS), Roland–Morris score and complications with acute traumatic compression fractures type A, treated with a standalone balloon kyphoplasty and cement augmentation with calcium phosphate (Calcibon™); follow-up time at a mean of 30 months (24–37 months). From August 2002 to August 2003, consecutive patients with traumatic compression fractures (Magerl type A) without neurological deficit underwent standalone kyphoplasty with Calcibon. We report here the pre-, post-operative and the follow-up results, applying the VAS (0–10) for pain rating, the Roland–Morris (0–24) disability score, CT-scan examination, detailed radiographic evaluation of vertebral body (VB) deformity and segmental kyphosis measurement. The pre-operative X-ray measurements, VAS and the 7 days Roland–Morris scores are compared with the post-operative and the 30 months follow-up findings. Twenty-eight patients with 33 treated fracture levels were included in this study. The mean initial vertebral deformity (VB kyphosis) was 17°, corrected to a post-operative of 6°. We noted a loss of correction at the follow-up in comparison to the post-operative standing X-ray at 24 h of 3° vertebral deformity and 3° segmental kyphosis. The VAS score demonstrates a decrease over time from a mean of 8.7–3.1 at 7 days and to 0.8 at the last follow-up. The Roland–Morris disability score demonstrates a similar improvement. We noticed no major complications related to the procedure. The mean cement resorption after 1 year was 20.3% (0.3–35.3%) and is related to the individual biological resorption process and is not predictable. All patients with vertebral fractures as sole medical problem were discharged within 48 h. All active patients returned to the same work within 3 months with the same working ability as before the accident. Standalone balloon kyphoplasty is a potential alternative mini-invasive technique to reduce the fractures. However, due to the intrinsic characteristic of calcium phosphate cement (Calcibon) we recommend the application of this biological cement for standalone reduction and stabilisation only in fractures type A1 and A3.1 in young patient. In case of higher destruction levels of the VB, we propose the utilisation of Calcibon associated with posterior instrumentation. Having regard to the pointed out indications, our preliminary results demonstrate a new possibility to treat this kind of fractures, allowing a rapid handling of pain, early discharge and return to normal activities.

Keywords

Bone cement Percutaneous treatment Kyphoplasty Traumatic fracture Compression fractures Calcium phosphate cement Osteoconduction Osteotransduction 

References

  1. 1.
    Adams MA et al (2000) Mechanical initiation of intervertebral disc degeneration. Spine 25:1625–1636PubMedCrossRefGoogle Scholar
  2. 2.
    Bai B et al (1999) The use of an injectable, biodegradable calcium phosphate bone substitute for the prophylactic augmentation of osteoporotic vertebrae and the management of vertebral compression fractures. Spine 24:1521–1526PubMedCrossRefGoogle Scholar
  3. 3.
    Brown WE, Chow LC (1983) A new calcium phosphate setting cement. J Dent Res 2:62Google Scholar
  4. 4.
    Chow LC et al (1998) Calcium phosphate cements. Cements Res Prog 215–238Google Scholar
  5. 5.
    Daniaux H (1986) Transpedicular repositioning and spongioplasty in fractures of the vertebral bodies of the lower thoracic and lumbar spine. Unfallchirurg 89(5):197–213PubMedGoogle Scholar
  6. 6.
    Driessens FC et al (1993) Formulation and setting times of some calcium orthophosphate cements: a pilot study. J Mater Sci Mater Med 4:503–508CrossRefGoogle Scholar
  7. 7.
    Driessens FC, Boltong MG, Wenz R (2000) Calcium phosphate bone cements: state of the Art 2000. In: 12th conference of the European society of biomechanics, Dublin, Ireland, 27–30th August 2000Google Scholar
  8. 8.
    Driessens FC et al (2002) Comparative study of some experimental or commercial calcium phosphate bone cements. Bioceramics, vol 11. In: Proceedings of the 11th international symposium on ceramics in medicine, pp 231–233Google Scholar
  9. 9.
    Fernandez E, Gil FJ, Best SM, Ginebra MP, Driessens FC, Planell JA (1998) Improvement of the mechanical properties of new calcium phosphate bone cements in the CaHPO4-α-Ca3(PO4)2 system: compressive strength and microstructural development. J Biomed Mater Res 41:560–567PubMedCrossRefGoogle Scholar
  10. 10.
    Frankenburg EP et al (1998) Biomechanical and histological evaluation of calcium phosphate cement. J Bone Joint Surg Am 80(8):1112–1124PubMedGoogle Scholar
  11. 11.
    Fujikawa K et al (1995) Histopathological reaction of calcium phosphate cement in periodontal bone defect. Dent Mater J 14:45–57PubMedGoogle Scholar
  12. 12.
    Garfin SR et al (2001) New technologies in spine: kyphoplasty and vertebroplasty for the treatment of painful osteoporotic compression fractures. Spine 26(14):1511–1515PubMedCrossRefGoogle Scholar
  13. 13.
    Hadjipavlou AG et al (1999) Pathomechanics and clinical relevance of disc degeneration and annular tear: a point-of-view review. Am J Orthop 28:561–571PubMedGoogle Scholar
  14. 14.
    Hillmeier J et al (2004) Augmentation von Wirbelkörperfrakturen mit einem neuen Calciumphosphate-Zement nach Ballon-Kphoplastie. Orthopäde 33:31–39PubMedCrossRefGoogle Scholar
  15. 15.
    Hutton WC et al (2000) Does long-term compressive loading on the intervertebral disc cause degeneration? Spine 25:2993–3004PubMedCrossRefGoogle Scholar
  16. 16.
    Khairoun I, Boltong MG, Driessens FC, Planell JA (1997) Effect of calcium carbonate on clinical compliance of apatitic calcium phosphate bone cement. J Biomed Mater Res 38(4):356–360PubMedCrossRefGoogle Scholar
  17. 17.
    Khairoun I et al (1998) Some factors controlling the inject ability of calcium phosphate bone cement. J Mater Sci Mater Med 9:425–428PubMedCrossRefGoogle Scholar
  18. 18.
    Kopylov P et al (1996) Injectable calcium phosphate in the treatment of distal radial fractures. J Hand Surg Br 21:768–771PubMedCrossRefGoogle Scholar
  19. 19.
    Liebermann I et al (2001) Initial outcome and efficacy of kyphoplasty in the treatment of painful osteoporotic vertebral compression fractures. Spine 26(14):1631–1638CrossRefGoogle Scholar
  20. 20.
    Magerl F et al (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201PubMedCrossRefGoogle Scholar
  21. 21.
    Müller U et al (1999) Treatment of thoracolumbar burst fractures without neurological deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion. Eur Spine J 8:284–289PubMedCrossRefGoogle Scholar
  22. 22.
    Oner FC et al (1998) Changes in the disc space after fractures of the thoracolumbar spine. J Bone Joint Surg Br 80:833–839PubMedCrossRefGoogle Scholar
  23. 23.
    Oner FC et al (1999) MRI findings of thoracolumbar spine fractures: a categorisation based on MRI examination of 100 fractures. Skeletal Radiol 28:433–443PubMedCrossRefGoogle Scholar
  24. 24.
    Ooms EM, Wolke JCG, Jansen JA (2000) Evaluation of a high strength calcium phosphate bone cement. In: 6th world biomaterials congress, Hawaii, 15–20 MayGoogle Scholar
  25. 25.
    Ooms EM, Wolke JGC, van der Waerden JPCM, Jansen JA (2002) Trabecular bone response to injectable calcium phosphate (Ca-P) cement. J Biomed Mater Res 61:9–18PubMedCrossRefGoogle Scholar
  26. 26.
    Ooms E et al (2002) Trabecular bone response to injectable calcium phosphate (Ca-P) cement. Wiley, New York (www.interscience.wiley.com)Google Scholar
  27. 27.
    Ooms EM, Egglezos EA, Wolke JGC, Jansen JA (2003a) Soft-tissue response to injectable calcium phosphate cements. Biomaterials 24:749–757CrossRefGoogle Scholar
  28. 28.
    Ooms EM, Wolke JCG, van de Heuvel MT, Jeschke B, Jansen JA (2003b) Histological evaluation of the bone response to calcium phosphate cement implanted in cortical bone. Biomaterials 24:989–1000CrossRefGoogle Scholar
  29. 29.
    Resch H et al (2000) Operative vs. konservative Behandlung von Frakturen des thorakolumbalen Übergangs. Unfallchirurg 103:281–288PubMedCrossRefGoogle Scholar
  30. 30.
    Shen WJ et al (2001) Nonoperative treatment versus posterior fixation for thoracolumbar junction burst fractures without neurologic deficit. Spine 26(9):1038–1045PubMedCrossRefGoogle Scholar
  31. 31.
    Tomita S et al (2003) Biomechanical evaluation of kyphoplasty and vertebroplasty with calcium phosphate cement in a simulated osteoporotic compression fracture. J Orthop Sci 8:192–197PubMedCrossRefGoogle Scholar
  32. 32.
    Trivedi JM (2002) Spinal trauma: therapy options and outcomes. Eur J Radiol 42:127–134PubMedCrossRefGoogle Scholar
  33. 33.
    Verlaan JJ et al (2002) Balloon vertebroplasty with calcium phosphate cement augmentation for direct restoration of traumatic thoracolumbar vertebral fracture. Spine 27(5):543–548PubMedCrossRefGoogle Scholar
  34. 34.
    Verlaan JJ et al (2004) Histological changes after vertebroplasty. J Bone Joint Surg 86:1230–1238PubMedGoogle Scholar
  35. 35.
    Wenz R, Boltong MG, Driessens FC (2000) Calcium phosphate bone cements: state of the art 1999. In: 6th world biomaterials congress, Hawaii, 15–20 MayGoogle Scholar
  36. 36.
    Wolke JGC, Wenz R, Ooms EM, Boltong MG, Driessens FC, Jansen JA (1999) Physiochemical properties, composition and in Vivo resorption behaviour of a high strength calcium phosphate cement. Concepts and clinical applications on ionic cements. In: 15th European conference on biomaterials, Arcachon, Bordeaux, FranceGoogle Scholar
  37. 37.
    Wood K et al (2003) Operative compared with non-operative treatment of a thoracolumbar burst fracture without neurological deficit. J Bone J Surg 85(5):773–781Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Gianluca Maestretti
    • 1
  • Claus Cremer
    • 1
  • Philippe Otten
    • 2
  • Roland Peter Jakob
    • 1
  1. 1.Department of Orthopaedic SurgeryHôpital Cantonal FribourgFribourgSwitzerland
  2. 2.Department of General SurgeryHôpital Cantonal FribourgFribourgSwitzerland

Personalised recommendations