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By Kai-Uwe Lewandrowski

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Bone Joint Surg 1994; 76B:155. 71. Perrin C, Jullien V, Padovani B, Blaive B. Percutaneous vertebroplasty complicated by pulmonary embolus of acrylic cement. Rev. Mal Respir 1999; 16:215–217. 72. Schildhauer TA, Bennett AP, Wright TM, Lane JM, O’Leary PF. Intravertebral body reconstruction with an injectable in situ-setting carbonated apatite: biomechanical evaluation of a minimally invasive technique. J. Orthop. Res 1999; 17:67–72. 73. Fujita H, Nakamura T, Tamura J, Kobayashi M, Katsura Y, Kokubo T, Kikutani T.

In vitro studies have demonstrated that both stiffness and strength are increased with PMMA in osteoporotic bone [17–19]. Because the fractured osteoporotic bone is so weak, the vertebra’s mechanical properties after augmentation are virtually that of the bone filler. Not all bone cements are equal. Different substances create different changes in strength and stiffness. In a cadaveric study, Orthocomp (Orthovita, Malvern, PA) resulted in significantly stronger and stiffer vertebrae than Simplex P (Howmedica, Rutherford, NJ) [19].

STIR images are particularly helpful in differentiating fracture from malignancy. For patients in whom MRI cannot be performed, a computerized tomogram (CT) is another option. These images give better bony detail and are © 2004 by Marcel Dekker, Inc. superior to MRI for characterizing the fracture, but they should be used in conjunction with a bone scan to determine fracture acuity [28]. VIII. SURGICAL TECHNIQUE: KYPHOPLASTY A. Setup Either general or local anesthesia with sedation can been used.

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ADVANCES IN SPINAL FUSION Molecular Science, Biomechanics, and C by Kai-Uwe Lewandrowski


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