Biomechanical efficacy of unipedicular versus bipedicular vertebroplasty for the management of osteoporotic compression fractures

Cadaveric study on the biomechanics of osteoporotic vertebral bodies augmented and not augmented with polymethylmethacrylate cement. To determine the strength and stiffness of osteoporotic vertebral bodies subjected to compression fractures and 1) not augmented, 2) augmented with unipedicular injection of cement, or 3) augmented with bipedicular injection of cement. Percutaneous vertebroplasty is a relatively new method of managing osteoporotic compression fractures, but it lacks biomechanical confirmation. Fresh vertebral bodies (L2-L5) were harvested from 10 osteoporotic spines (T scores range, -3.7 to -8.8) and compressed in a materials testing machine to determine intact strength and stiffness. They were then repaired using a transpedicular injection of cement (unipedicular or bipedicular), or they were unaugmented and recrushed. Results suggest that unipedicular and bipedicular cement injection restored vertebral body stiffness to intact values, whereas unaugmented vertebral bodies were significantly more compliant than either injected or intact vertebral bodies. Vertebral bodies injected with cement (both bipedicular and unipedicular) were significantly stronger than the intact vertebral bodies, whereas unaugmented vertebral bodies were significantly weaker. There was no significant difference in loss in vertebral body height between any of the augmentation groups. This study suggests that unipedicular and bipedicular injection of cement, as used during percutaneous vertebroplasty, increases acute strength and restores stiffness of vertebral bodies with compression fractures.