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Optimizing bone cement stiffness for vertebroplasty through biomechanical effects analysis based on patient-specific three-dimensional finite element modeling

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Abstract

Vertebroplasty is a common and effective treatment for symptomatic osteoporotic vertebral compression fractures. However, the cemented and adjacent vertebras have a risk of recollapse due to largely unassured mechanisms, among which excessive stiffness of bone cement may be an important risk factor. This study aimed to find the most appropriate range of bone cement stiffness by analyzing its biomechanical effects on the augmented and adjacent vertebras of individual patient after vertebroplasty. A three-dimensional finite element model of T11-L1 osteoligamentous vertebras was reconstructed according to individual computed tomography data and validated by post mortem human subject experiment in literatures. Bone cement of varying stiffness was injected into the trabecular core of the T12 vertebra simulatively. The maximum von Mises stresses on cancellous and cortical bones of T11-L1 vertebras were analyzed under the loading conditions of flexion, extension, bending, and torsion. For the adjacent T11 and L1 vertebras, the stepwise elevation of the bone cement elastic modulus increased the maximum von Mises stress on the cancellous bone, but its effect on cortical bone was negligible. For the augmented T12 vertebra, the stresses on cancellous bone increased slightly under the loading condition of lateral bending and remained no impact on cortical bone. The linear interpolation revealed that the most suitable range of cement elastic modulus is 833.1 and 1408.1 Mpa for this patient. Increased elastic modulus of bone cement may lead to a growing risk of recollapse for the cemented vertebra as well as the adjacent vertebras. Our study provides a fresh perspective in clinical optimization of individual therapy in vertebroplasty.

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Acknowledgments

Finite element analyses were performed at the Department of Mechanical Engineering, Embry-Riddle Aeronautical University. The authors specially thank Xianping Du for technical assistance. This study was funded by the grants of the New Xiangya Talent Project of the Third Xiangya Hospital of Central South University (JY201502).

Funding

This study was funded by the grants of the New Xiangya Talent Project of the Third Xiangya Hospital of Central South University (JY201502).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China

    Yi Peng, Jinsong Li, Ruisen Zhan, Weiguo Wang, Song Wu & Shijie Chen

  2. Department of Mechanical Engineering, Embry-Riddle Aeronautical University, Daytona Beach, FL, 32114, USA

    Xianping Du

  3. Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China

    Lihua Huang

  4. Xiangya Medical School of Central South University, Changsha, 410013, Hunan, China

    Biaoxiang Xu

  5. Department of Burns and Plastic Surgery, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China

    Cheng Peng

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  1. Yi Peng
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  2. Xianping Du
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  3. Lihua Huang
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  4. Jinsong Li
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  6. Weiguo Wang
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  8. Song Wu
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  9. Cheng Peng
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  10. Shijie Chen
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Contributions

Shijie Chen and Yi Peng designed the study and wrote the first draft of the manuscript. Jinsong Li, Biaoxiang Xu, and Weiguo Wang collected the data. Xianping Du completed finite element modeling, computation and analysis. Cheng Peng, Song Wu, Lihua Huang, and Ruisen Zhan participated in data analysis and interpretation and revision of the manuscript. All authors have approved the final version of the paper.

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Correspondence to Song Wu, Cheng Peng or Shijie Chen.

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Peng, Y., Du, X., Huang, L. et al. Optimizing bone cement stiffness for vertebroplasty through biomechanical effects analysis based on patient-specific three-dimensional finite element modeling. Med Biol Eng Comput 56, 2137–2150 (2018). https://doi.org/10.1007/s11517-018-1844-x

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