The effectiveness of percutaneous vertebroplasty is determined by the patient-specific bone condition and the treatment strategy

Rene P. Widmer Soyka, Benedikt Helgason, Javad Hazrati Marangalou, Joop P. van den Bergh, Bert van Rietbergen, Stephen J. Ferguson

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Abstract

Purpose Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. Methods A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. Results The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. Conclusions We conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.
Original languageEnglish
Article numbere0151680
Pages (from-to)e0151680-
JournalPLoS ONE
Volume11
Issue number4
DOIs
Publication statusPublished - 2016

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Vertebroplasty
Bone
bones
cement
Bone and Bones
Bone Cements
randomized clinical trials
analgesia
vertebrae
Polymethyl Methacrylate
Therapeutics
Infiltration
injection
Reinforcement
Lumbar Vertebrae
Randomized Controlled Trials
Pain
Injections

Keywords

  • METIS-319015
  • IR-102197

Cite this

Widmer Soyka, R. P., Helgason, B., Hazrati Marangalou, J., van den Bergh, J. P., van Rietbergen, B., & Ferguson, S. J. (2016). The effectiveness of percutaneous vertebroplasty is determined by the patient-specific bone condition and the treatment strategy. PLoS ONE, 11(4), e0151680-. [e0151680]. https://doi.org/10.1371/journal.pone.0151680
Widmer Soyka, Rene P. ; Helgason, Benedikt ; Hazrati Marangalou, Javad ; van den Bergh, Joop P. ; van Rietbergen, Bert ; Ferguson, Stephen J. / The effectiveness of percutaneous vertebroplasty is determined by the patient-specific bone condition and the treatment strategy. In: PLoS ONE. 2016 ; Vol. 11, No. 4. pp. e0151680-.
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abstract = "Purpose Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. Methods A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. Results The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. Conclusions We conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.",
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Widmer Soyka, RP, Helgason, B, Hazrati Marangalou, J, van den Bergh, JP, van Rietbergen, B & Ferguson, SJ 2016, 'The effectiveness of percutaneous vertebroplasty is determined by the patient-specific bone condition and the treatment strategy', PLoS ONE, vol. 11, no. 4, e0151680, pp. e0151680-. https://doi.org/10.1371/journal.pone.0151680

The effectiveness of percutaneous vertebroplasty is determined by the patient-specific bone condition and the treatment strategy. / Widmer Soyka, Rene P.; Helgason, Benedikt; Hazrati Marangalou, Javad; van den Bergh, Joop P.; van Rietbergen, Bert; Ferguson, Stephen J.

In: PLoS ONE, Vol. 11, No. 4, e0151680, 2016, p. e0151680-.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - The effectiveness of percutaneous vertebroplasty is determined by the patient-specific bone condition and the treatment strategy

AU - Widmer Soyka, Rene P.

AU - Helgason, Benedikt

AU - Hazrati Marangalou, Javad

AU - van den Bergh, Joop P.

AU - van Rietbergen, Bert

AU - Ferguson, Stephen J.

PY - 2016

Y1 - 2016

N2 - Purpose Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. Methods A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. Results The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. Conclusions We conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.

AB - Purpose Vertebral fragility fractures are often treated by injecting bone cement into the collapsed vertebral bodies (vertebroplasty). The mechanisms by which vertebroplasty induces pain relief are not completely understood yet and recent debates cast doubt over the outcome of the procedure. The controversy is intensified by inconsistent results of randomized clinical trials and biomechanical studies that have investigated the effectiveness or the change in biomechanical response due to the reinforcement. The purpose of this study was to evaluate the effectiveness of vertebroplasty, by varying the relevant treatment parameters and (a) computationally predicting the improvement of the fracture risk depending on the chosen treatment strategy, and (b) identifying the determinants of a successful treatment. Methods A Finite Element model with a patient-specific failure criterion and direct simulation of PMMA infiltration in four lumbar vertebrae was used to assess the condition of the bone under compressive load before and after the virtual treatment, simulating in a total of 12000 virtual treatments. Results The results showed that vertebroplasty is capable of reducing the fracture risk by magnitudes, but can also have a detrimental effect. Effectiveness was strongly influenced by interactions between local bone quality, cement volume and injection location. However, only a moderate number of the investigated treatment strategies were able to achieve the necessary improvement for preventing a fracture. Conclusions We conclude that the effectiveness of vertebroplasty is sensitive to the patient’s condition and the treatment strategy.

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JO - PLoS ONE

JF - PLoS ONE

SN - 1932-6203

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