In silico evaluation of stress distribution after vertebral body augmentation with conventional acrylics, composites and glass polyalkenoate cements.

There exists clinical evidence of fractures in adjacent vertebrae subsequent to vertebral augmentation procedures, such as vertebroplasty (VP) and kyphoplasty (KP). A potential contributory factor to such fractures may be the excessive mismatch of mechanical properties between contemporary bone cements (i.e. polymethyl methacrylate (PMMA) and bisphenol-a-glycidyl dimethacrylate (BIS-GMA)) and bone. Aluminum-free glass polyalkenoate cements (GPCs) present an interesting alternative to conventional bone cements. GPCs adhere to the philosophy that implant materials should have mechanical characteristics similar to those of the bone, and also offer chemical adhesion and intrinsic bioactivity. However, their influence on the loading patterns of augmented vertebrae (as compared with conventional bone cements) is not available in the literature. The present work investigates how the moduli of PMMA, BIS-GMA and GPC implants affect the stress distribution within a single, augmented vertebra, in both healthy and osteoporotic states. Using a finite element model of the L4 vertebra derived from computed tomography data, with simulated augmentation, it was found that, as cement stiffness increased, stress was redistributed from the cortical and trabecular bone to the cement implant. The GPC implant exhibited the least effect on stress redistribution in both the healthy and osteoporotic models compared to its acrylic counterparts. The significance of this work is that, under simulated physiological loading conditions, aluminum-free GPCs exhibit stress distribution throughout the vertebral body similar to that of the healthy bone. In comparison to conventional augmentation materials, the use of aluminum-free GPCs in VP and KP may help to ameliorate the clinical complication of adjacent vertebral body compression fractures.

Effects of intervertebral disk degeneration on the flexibility of the human thoracolumbar spine.

The objective of this study was to investigate the effects of intervertebral disk degeneration on the flexibility of the thoracolumbar spine in flexion and extension, both experimentally and computationally. A seven-level biomechanically tested human cadaveric spine (T11-L5) and a 3D finite element model of the same thoracolumbar spine were used for this purpose. The anatomically accurate computer model was generated from detailed computed tomography images and included the vertebral shell, the trabecular centrum, cartilage endplates, intervertebral disks, seven spinal ligament groups, and the facet joints. The cadaveric spinal segment and the specimen-specific finite element model were subjected to various compressive loads ranging from 75 to 975 N using the follower load principle and an oscillating bending moment of +/-5 Nm applied in the sagittal plane. The biomechanical behavior of the finite element model of the spine was validated with the experimental mechanical test data for the corresponding physical thoracolumbar spine specimen. In addition, the effect of intervertebral disk material property variation within the thoracolumbar spinal column on the spinal flexibility was extensively studied. The results of this study provided significant insight into how mechanical properties of the intervertebral disk influence spinal flexibility along the thoracolumbar spinal column. It was found that in order to get comparable results between experimental and computed data, the material properties of the intervertebral disks had to vary along the spinal column. However, these effects are diminished with increasing axial compressive load. Because of the trend between disk properties and spinal level, we further concluded that there might be a mechanism at play that links endplate size, body weight fraction, and segmental flexibility. More studies are needed to further investigate that relationship.