In silico investigation of vertebroplasty as a stand-alone treatment for vertebral burst fractures

Abstract Background The use of percutaneous vertebroplasty as a stand-alone treatment for stable vertebral burst fractures has been investigated in vitro and in clinical studies. These studies present inconsistent results on the mechanical response of vertebroplasty-treated burst fractures. In addition, observations of the loss of sagittal alignment after vertebroplasty raise questions on the applicability of vertebroplasty for burst fractures. Therefore, the aim of this study was to investigate the mechanical stability of burst fractures after stand-alone treatment by vertebroplasty. Methods Finite element simulations were performed with models generated from two laboratory-induced burst fractures in human throracolumbar specimens. The burst fracture models were virtually injected with various cement volumes using a unipedicular or bipedicular approach. The models were subjected to four individual loads (compression, lateral bending, extension and torsion) and a multi-axial load case in the physiological range. Findings All treated burst fractures showed improvements in stiffness and a reduction in inter-fragmentary displacements, thus potentially providing a suitable mechanical environment for fracture healing. However, large volumes of the trabecular bone (< 43%), cement (< 53%) and bone-cement composite (< 58%) were predicted to experience strain levels exceeding the yield point. While damage was not specifically modeled, this implies a potential collapse of the treated vertebra due to local failure. Interpretation To improve the primary stability and to prevent the collapse of treated burst fractures, the use of posterior instrumentation is suggested as an adjunct to vertebroplasty.