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Tough and injectable fiber reinforced calcium phosphate cement as an alternative to polymethylmethacrylate cement for vertebral augmentation: a biomechanical study

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Abstract

Vertebral compression fractures (VCFs) are a very common problem among the elderly, which ultimately result in severe pain and a drastically reduced quality of life. An effective treatment for VCFs is the minimally invasive augmentation of the damaged vertebrae through vertebroplasty and/or kyphoplasty. These surgical procedures treat the affected vertebrae by injection of poly(methyl methacrylate) cement (PMMA) into the vertebral body. However, clinical use of PMMA cement is associated with major drawbacks. Bioceramic cements such as injectable calcium phosphate cements (CPC) exhibit a superior osteocompatibility over PMMA cements, but are too brittle for load-bearing applications. Here, we evaluated the handling and mechanical properties of a recently developed CPC formulation containing both poly(vinyl alcohol) (PVA) fibers and carboxymethyl cellulose (CMC) as an alternative to PMMA cement for vertebro- and kyphoplasty. Our results demonstrate that the addition of CMC rendered fiber-reinforced CPC injectable without negatively affecting its mechanical properties. Further, an ex vivo mechanical analysis clearly showed that extravasation of PVA fiber-reinforced CPC with CMC into trabecular bone was limited as compared to PMMA. Finally, we observed that the ex vivo biomechanical performance of vertebrae treated with CMC and PVA fibers was similar to PMMA-treated vertebrae. The obtained data suggests that PVA fiber-reinforced CPCs with CMC possesses adequate handling, mechanical and structural characteristics for vertebro- and kyphoplasty procedures. These data pave the way for future preclinical studies on the feasibility of treating vertebral compression fractures using PVA fiber-reinforced CPC with CMC.

Graphical abstract: Tough and injectable fiber reinforced calcium phosphate cement as an alternative to polymethylmethacrylate cement for vertebral augmentation: a biomechanical study

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Supplementary files

Article information


Submitted
13 Mar 2020
Accepted
15 Jun 2020
First published
24 Jun 2020

This article is Open Access

Biomater. Sci., 2020, Advance Article
Article type
Paper

Tough and injectable fiber reinforced calcium phosphate cement as an alternative to polymethylmethacrylate cement for vertebral augmentation: a biomechanical study

S. de Lacerda Schickert, J. C. Pinto, J. Jansen, S. C. G. Leeuwenburgh and J. J. J. P. van den Beucken, Biomater. Sci., 2020, Advance Article , DOI: 10.1039/D0BM00413H

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  • For reproduction of material from NJC:
    [Original citation] - Published by The Royal Society of Chemistry (RSC) on behalf of the Centre National de la Recherche Scientifique (CNRS) and the RSC.
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    [Original citation] - Published by the PCCP Owner Societies.
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    [Original citation] - Published by The Royal Society of Chemistry (RSC) on behalf of the European Society for Photobiology, the European Photochemistry Association, and RSC.
  • For reproduction of material from all other RSC journals:
    [Original citation] - Published by The Royal Society of Chemistry.

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