TY - JOUR
T1 - CT-based structural analyses of vertebral fractures with polymeric augmentation
T2 - A study of cadaveric three-level spine segments
AU - Rezaei, Asghar
AU - Giambini, Hugo
AU - Miller, Alan L.
AU - Xu, Hao
AU - Xu, Haocheng
AU - Li, Yong
AU - Yaszemski, Michael J.
AU - Lu, Lichun
N1 - Publisher Copyright:
© 2021
PY - 2021/6
Y1 - 2021/6
N2 - Pathologic vertebral fractures due to metastasis can occur under normal physiologic activities, leading to pain and neurologic deficit. Prophylactic vertebroplasty is a technique used to augment vertebral strength and reduce the risk of fracture. Currently, no technique is available to objectively assess vertebral fracture risk in metastatically-involved vertebral bodies. The aim of the current study was to develop an image-based computational technique to estimate fracture force outcomes during bending. To this end, mechanical testing was performed on intact, simulated defect, PMMA-augmented, and PPF-augmented 3-level spine segments from both sexes under a compression/flexion-type loading condition. The augmentation performance of poly(methyl methacrylate) (PMMA) and poly(propylene fumarate) (PPF) were also evaluated and compared. Cylindrical defects were created in 3-level spine segments with attached posterior elements and ligaments. Using CT images of each segment, a rigidity analysis technique was developed and used for predicting fracture forces during bending. On average, PPF strengthened the segments by about 630 N, resulting in fracture forces similar to those observed in the intact and PMMA-augmented groups. Female spines fractured at about 1150 N smaller force than did male spines. Rigidity analysis, along with age, explained 66% variability in experimental outcomes. This number increased to 74% when vertebral size and age were added to the rigidity analysis as explanatory variables. Both PPF and PMMA similarly increased fracture strength to the level of intact specimens. The results suggest that PPF can be a suitable candidate for augmentation purposes and rigidity analysis can be a promising predicting tool for vertebral fracture forces.
AB - Pathologic vertebral fractures due to metastasis can occur under normal physiologic activities, leading to pain and neurologic deficit. Prophylactic vertebroplasty is a technique used to augment vertebral strength and reduce the risk of fracture. Currently, no technique is available to objectively assess vertebral fracture risk in metastatically-involved vertebral bodies. The aim of the current study was to develop an image-based computational technique to estimate fracture force outcomes during bending. To this end, mechanical testing was performed on intact, simulated defect, PMMA-augmented, and PPF-augmented 3-level spine segments from both sexes under a compression/flexion-type loading condition. The augmentation performance of poly(methyl methacrylate) (PMMA) and poly(propylene fumarate) (PPF) were also evaluated and compared. Cylindrical defects were created in 3-level spine segments with attached posterior elements and ligaments. Using CT images of each segment, a rigidity analysis technique was developed and used for predicting fracture forces during bending. On average, PPF strengthened the segments by about 630 N, resulting in fracture forces similar to those observed in the intact and PMMA-augmented groups. Female spines fractured at about 1150 N smaller force than did male spines. Rigidity analysis, along with age, explained 66% variability in experimental outcomes. This number increased to 74% when vertebral size and age were added to the rigidity analysis as explanatory variables. Both PPF and PMMA similarly increased fracture strength to the level of intact specimens. The results suggest that PPF can be a suitable candidate for augmentation purposes and rigidity analysis can be a promising predicting tool for vertebral fracture forces.
KW - Biomechanics of spine
KW - Mechanical testing
KW - Rigidity analysis
KW - Vertebral augmentation
KW - Vertebral fracture
UR - http://www.scopus.com/inward/record.url?scp=85104427325&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85104427325&partnerID=8YFLogxK
U2 - 10.1016/j.compbiomed.2021.104395
DO - 10.1016/j.compbiomed.2021.104395
M3 - Article
C2 - 33872967
AN - SCOPUS:85104427325
SN - 0010-4825
VL - 133
JO - Computers in Biology and Medicine
JF - Computers in Biology and Medicine
M1 - 104395
ER -