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Comparison of Osseointegration in Different Intravertebral Fixators

Abstract

Purpose

Percutaneous minimally invasive spinal surgery is performed to manage vertebral compression fractures. The novel modular spine block (MSB) is a spinal fixator designed to provide cementless intravertebral fixation. This study tested the rate of new bone formation in a porcine model following MSB fixation.

Methods

A total of 24 MSBs were implanted in four pigs that served as porcine animal models: solid MSB designated as MSB-0, perforated MSB as MSB-1, hollow MSB as MSB-2, porous 3D-printed MSB as MSB-3. Commercially available intravertebral expandable pillars (IVEP) were also implanted, to serve as a comparison with the MSBs. All pigs underwent X-ray imaging, computed tomography (CT), micro-CT, and histomorphometry. The bone volume fraction (bone volume/tissue volume, BV/TV), bone surface density (bone surface area/tissue volume, BS/TV), trabecular bone thickness (TBT), trabecular bone number (TBN), and trabecular bone separation (TBS) were evaluated.

Results

All fixators were securely implanted without any major complications. Adequate alignment of the implants was confirmed radiologically. Marked bone growth was observed on micro-CT and histomorphometry. The average results of BV/TV, BS/TV, TBT, and TBN were the highest in the MSB-2 cases, whereas the values of TBS were the lowest. No statistically significant differences were found between the various intravertebral fixators used.

Conclusions

These findings suggest that MSBs have a similar positive effect on osseointegration as other commercially available cementless intravertebral device. Since these data were obtained from porcine models, further clinical research is required to confirm the reproducibility of these data in humans.

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Data Availability

All authors make sure that all data and materials as well as software application or custom code support their published claims and comply with field standards.

Code Availability

All authors make sure that all data and materials as well as software application or custom code support their published claims and comply with field standards.

References

  1. Chapman, J., Smith, J. S., Kopjar, B., Vaccaro, A. R., Arnold, P., Shaffrey, C. I., & Fehlings, M. G. (2013). The AO Spine North America Geriatric Odontoid Fracture Mortality Study: A retrospective review of mortality outcomes for operative versus nonoperative treatment of 322 patients with long-term follow-up. Spine (Phila Pa 1976), 38(13), 1098–1104.

    Article  Google Scholar 

  2. Chotigavanich, C., Sanpakit, S., Wantthanaapisith, T., Thanapipatsiri, S., & Chotigavanich, C. (2009). The surgical treatment of the osteoporotic vertebral compression fracture in the elderly patients with the spinal instrumentation. Journal of the Medical Association of Thailand, 92(Suppl5), S109-115.

    PubMed  Google Scholar 

  3. Reinhold, M., Knop, C., Beisse, R., Audigé, L., Kandziora, F., Pizanis, A., Pranzl, R., Gercek, E., Schultheiss, M., Weckbach, A., Bühren, V., & Blauth, M. (2010). Operative treatment of 733 patients with acute thoracolumbar spinal injuries: Comprehensive results from the second, prospective, Internet-based multicenter study of the Spine Study Group of the German Association of Trauma Surgery. European Spine Journal, 19(10), 1657–1676.

    CAS  Article  Google Scholar 

  4. Pourtaheri, S., Luo, W., Cui, C., & Garfin, S. (2018). Vertebral augmentation is superior to nonoperative care at reducing lower back pain for symptomatic osteoporotic compression fractures: A meta-analysis. Clinical Spine Surgery: A Spine Publication, 31(8), 339–344.

    Article  Google Scholar 

  5. Wang, H., Sribastav, S. S., Ye, F., Yang, C., Wang, J., Liu, H., & Zheng, Z. (2015). Comparison of percutaneous vertebroplasty and balloon kyphoplasty for the treatment of single level vertebral compression fractures: A meta-analysis of the literature. Pain Physician, 18(3), 209–222.

    PubMed  Google Scholar 

  6. Flors, L., Lonjedo, E., Leiva-Salinas, C., Martí-Bonmatí, L., Martínez-Rodrigo, J. J., López-Pérez, E., Figueres, G., & Raoli, I. (2009). Vesselplasty: A new technical approach to treat symptomatic vertebral compression fractures. AJR: American Journal of Roentgenology, 193(1), 218–226.

    Article  Google Scholar 

  7. Eschler, A., Ender, S. A., Ulmar, B., Herlyn, P., Mittlmeier, T., & Gradl, G. (2014). Cementless fixation of osteoporotic VCFs using titanium mesh implants (OsseoFix): Preliminary results. BioMed Research International, 2014, 853897.

    Article  Google Scholar 

  8. Jacobson, R. E. (2020). The use of SpineJack intravertebral implant for the correction of recurrent vertebral fracture after kyphoplasty. Cureus, 12(4), e7599.

    PubMed  PubMed Central  Google Scholar 

  9. Belkoff, S. M., & Molloy, S. (2003). Temperature measurement during polymerization of polymethylmethacrylate cement used for vertebroplasty. Spine (Phila Pa 1976), 28(14), 1555–1559.

    Google Scholar 

  10. Fribourg, D., Tang, C., Sra, P., Delamarter, R., & Bae, H. (2004). Incidence of subsequent vertebral fracture after kyphoplasty. Spine (Phila Pa 1976), 29(20), 2270–2276.

    Article  Google Scholar 

  11. Hsieh, J. Y., Wu, C. D., Wang, T. M., Chen, H. Y., Farn, C. J., & Chen, P. Q. (2013). Reduction of the domino effect in osteoporotic vertebral compression fractures through short-segment fixation with intravertebral expandable pillars compared to percutaneous kyphoplasty: A case control study. BMC Musculoskeletal Disorders, 14, 75.

    Article  Google Scholar 

  12. Hsieh, J. Y., Chen, P. Q., & Wang, J. H. (2018). Minimally invasive open reduction and internal fixation for osteoporotic vertebral compression fractures: Technical report and mid-term outcomes. Open Journal of Orthopedics, 8(9), 337–350.

    Article  Google Scholar 

  13. Hsieh, J. Y. (2021). Minimally invasive management of osteoporotic vertebral compression fractures. In P. Q. Chen, R. M. Lin, & K. S. Tsai (Eds.), Osteoporosis of the spine. Asian perspectives (pp. 615–634). World Scientific.

  14. Castellani, C., Lindtner, R. A., Hausbrandt, P., Tschegg, E., Stanzl-Tschegg, S. E., Zanoni, G., Beck, S., & Weinberg, A. M. (2011). Bone-implant interface strength and osseointegration: Biodegradable magnesium alloy versus standard titanium control. Acta Biomaterialia, 7(1), 432–440.

    CAS  Article  Google Scholar 

  15. Li, G., Qian, H., Guo, S., Wang, D., Sun, C., Du, Y., Cheng, J., & Jiang, H. (2019). Assessment of aging characteristics of female condylar trabecular structure by cone-beam computed tomography. Oral Radiology, 35(1), 16–22.

    Article  Google Scholar 

  16. Ghofrani, H., Nunn, T., Robertson, C., Mahar, A., Lee, Y., & Garfin, S. (2010). An evaluation of fracture stabilization comparing kyphoplasty and titanium mesh repair techniques for vertebral compression fractures: Is bone cement necessary? Spine (Phila Pa 1976), 35(16), E768–E773.

    Article  Google Scholar 

  17. Upasani, V. V., Robertson, C., Lee, D., Tomlinson, T., & Mahar, A. T. (2010). Biomechanical comparison of kyphoplasty versus a titanium mesh implant with cement for stabilization of vertebral compression fractures. Spine (Phila Pa 1976), 35(19), 1783–1788.

    Article  Google Scholar 

  18. Ender, S. A., Gradl, G., Ender, M., Langner, S., Merk, H. R., & Kayser, R. (2014). Osseofix® system for percutaneous stabilization of osteoporotic and tumorous vertebral compression fractures—Clinical and radiological results after 12 months. Rofo, 186(4), 380–387.

    CAS  PubMed  Google Scholar 

  19. Lee, J., & Song, K. S. (2020). Transpedicular intravertebral cage augmentation in a patient with neurologic deficits after severely collapsed kummel disease: Minimum 2-year follow-up. World Neurosurgery, 135, 146–155.

    Article  Google Scholar 

  20. Graillon, T., Farah, K., Rakotozanany, P., Blondel, B., Adetchessi, T., Dufour, H., & Fuentes, S. (2016). Anterior approach with expandable cage implantation in management of unstable thoracolumbar fractures: Results of a series of 93 patients. Neuro-Chirurgie, 62(2), 78–85.

    CAS  Article  Google Scholar 

  21. Müller, R., Van Campenhout, H., Van Damme, B., Van Der Perre, G., Dequeker, J., Hildebrand, T., & Rüegsegger, P. (1998). Morphometric analysis of human bone biopsies: A quantitative structural comparison of histological sections and micro-computed tomography. Bone, 23(1), 59–66.

    Article  Google Scholar 

  22. de Oliveira, R. C., Leles, C. R., Lindh, C., & Ribeiro-Rotta, R. F. (2012). Bone tissue microarchitectural characteristics at dental implant sites. Part 1: Identification of clinical-related parameters. Clinical Oral Implants Research, 23(8), 981–986.

    Article  Google Scholar 

  23. Keller, J. C., Schneider, G. B., Stanford, C. M., & Kellogg, B. (2003). Effects of implant microtopography on osteoblast cell attachment. Implant Dentistry, 12(2), 175–181.

    Article  Google Scholar 

  24. Parkinson, I. H., Badiei, A., Stauber, M., Codrington, J., Muller, R., & Fazzalari, N. L. (2012). Vertebral body bone strength: The contribution of individual trabecular element morphology. Osteoporosis International, 23(7), 1957–1965.

    CAS  Article  Google Scholar 

  25. Vasconcellos, L. M., Leite, D. O., Oliveira, F. N., Carvalho, Y. R., & Cairo, C. A. (2010). Evaluation of bone ingrowth into porous titanium implant: Histomorphometric analysis in rabbits. Brazilian Oral Research, 24(4), 399–405.

    Article  Google Scholar 

  26. Karageorgiou, V., & Kaplan, D. (2005). Porosity of 3D biomaterial scaffolds and osteogenesis. Biomaterials, 26(27), 5474–5491.

    CAS  Article  Google Scholar 

  27. Hartmann, F., Griese, M., Dietz, S. O., Kuhn, S., Rommens, P. M., & Gercek, E. (2015). Two-year results of vertebral body stenting for the treatment of traumatic incomplete burst fractures. Minimally Invasive Therapy and Allied Technologies, 24(3), 161–166.

    Article  Google Scholar 

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Acknowledgements

This study was approved by National Taiwan University Hospital. The authors wish to thank all the members who participated in this study.

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Authors and Affiliations

Authors

Contributions

Y-YH designed the study. J-YH participated in the conception, acquisition, analysis and interpretation of the data, drafting, and final preparation of the manuscript. J-HW and P-QC revised the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Yi-You Huang.

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Conflict of interest

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

Ethical Approval

The experimental protocol and surgical procedures were conducted with the approval of the Institutional Animal Care and Use Committee of Pig model Animal Technology Co., Ltd. (Approval No. PIG-107012).

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Not applicable.

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All authors will either grant the Publisher an exclusive license to publish the article.

Supplementary Information

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40846_2022_698_MOESM1_ESM.jpg

Supplementary file1 (JPG 179 kb)—Supplemental Figure 1—Procedure of MSB fixation (from left to right): transpedicular insertion of the first MSB segment, guided by a template plug, expansion by a thin tamper, expansion by a thick tamper, and second MSB segment fixation.

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Hsieh, JY., Wang, JH., Chen, PQ. et al. Comparison of Osseointegration in Different Intravertebral Fixators. J. Med. Biol. Eng. 42, 196–203 (2022). https://doi.org/10.1007/s40846-022-00698-4

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  • DOI: https://doi.org/10.1007/s40846-022-00698-4

Keywords

  • Vertebral compression fractures
  • Cementless
  • Modular spine blocks
  • Intravertebral fixation
  • Osseointegration