Histological and radiographic evaluation of polymethylmethacrylate with two different concentrations of barium sulfate in a sheep vertebroplasty model.

Percutaneous vertebral augmentation with PMMA has been widely performed and usually provides good pain relief and stabilization of fractured vertebrae. Adequate visualization of PMMA during injection is desirable to minimize cement extravasation, so contrast agents such as barium sulfate are commonly added to the PMMA. The aim of this study was to evaluate the differences of histology and radiographic visualization when different concentrations of barium sulfate are mixed with PMMA. Six sheep were utilized in this study. Three vertebrae of each animal were exposed via retroperitoneal approach, and a cavity was created and then filled with either 10% or 30% BaSO4/PMMA, or left empty. Vertebrae were harvested and analyzed radiographically and histologically 12 and 90 days after surgery. Average CT value of the 30% BaSO4/PMMA group was 2.4-fold higher than that of the 10% BaSO4/PMMA group. Foreign-body giant cells were recognized around BaSO4particles at 90 days in the 30% BaSO4 group, whereas few particles were recognized in the 10% group at 90 days, or in either group at 12 days. A very mild giant-cell reaction is induced by a higher concentration of BaSO4 in PMMA, but the marked improvement in cement visualization by increased BaSO4 may be important to minimize more serious complications of cement extravasation during PMMA injection.

[1]  J. Laredo,et al.  Complications of percutaneous vertebroplasty and their prevention , 2004, Skeletal Radiology.

[2]  I. Lieberman,et al.  Vertebroplasty and Kyphoplasty for Osteolytic Vertebral Collapse , 2003, Clinical orthopaedics and related research.

[3]  Thomas W Bauer,et al.  Histologic Evaluation of Human Vertebral Bodies After Vertebral Augmentation With Polymethyl Methacrylate , 2003, Spine.

[4]  K. Kip,et al.  Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. , 2003, Radiology.

[5]  L. Cristofolini,et al.  Fatigue strength of PMMA bone cement mixed with gentamicin and barium sulphate vs pure PMMA , 2003, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[6]  J. Ledlie,et al.  Balloon kyphoplasty: one-year outcomes in vertebral body height restoration, chronic pain, and activity levels. , 2003, Journal of neurosurgery.

[7]  C. K. Lee,et al.  Leakage of cement in percutaneous transpedicular vertebroplasty for painful osteoporotic compression fractures. , 2003, The Journal of bone and joint surgery. British volume.

[8]  J. Planell,et al.  Mechanical performance of acrylic bone cements containing different radiopacifying agents. , 2002, Biomaterials.

[9]  I. Lieberman,et al.  Initial Outcome and Efficacy of “Kyphoplasty” in the Treatment of Painful Osteoporotic Vertebral Compression Fractures , 2001, Spine.

[10]  Mark A. Reiley,et al.  New Technologies in Spine: Kyphoplasty and Vertebroplasty for the Treatment of Painful Osteoporotic Compression Fractures , 2001, Spine.

[11]  J. Heiss,et al.  Root and Spinal Cord Compression from Methylmethacrylate Vertebroplasty , 2001, Spine.

[12]  K. Harrington,et al.  Major neurological complications following percutaneous vertebroplasty with polymethylmethacrylate : a case report. , 2001, The Journal of bone and joint surgery. American volume.

[13]  R. Brooks,et al.  The effects of particulate bone cements at the bone-implant interface. , 2001, The Journal of bone and joint surgery. British volume.

[14]  S. Belkoff,et al.  Percutaneous vertebroplasty: a developing standard of care for vertebral compression fractures. , 2001, AJNR. American journal of neuroradiology.

[15]  B Delcambre,et al.  Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: an open prospective study. , 1999, The Journal of rheumatology.

[16]  H. Deramond,et al.  Percutaneous vertebroplasty with polymethylmethacrylate. Technique, indications, and results. , 1998, Radiologic clinics of North America.

[17]  J. Chiras,et al.  [Percutaneous vertebral surgery. Technics and indications]. , 1997, Journal of neuroradiology. Journal de neuroradiologie.

[18]  D. Murray,et al.  Radio-opaque Agents In Bone Cement Increase Bone Resorption , 1997 .

[19]  R. Assaker,et al.  Percutaneous vertebroplasty for osteolytic metastases and myeloma: effects of the percentage of lesion filling and the leakage of methyl methacrylate at clinical follow-up. , 1996, Radiology.

[20]  L. Topoleski,et al.  Effect of BaSO4 on the fatigue crack propagation rate of PMMA bone cement. , 1996, Journal of biomedical materials research.

[21]  J. Chiras,et al.  Spinal metastases: indications for and results of percutaneous injection of acrylic surgical cement. , 1996, Radiology.

[22]  F. Fernández,et al.  Radiohistology and histochemistry of barium granuloma of the colon and rectum. , 1992, Histology and histopathology.

[23]  C. Mottolese,et al.  [Percutaneous injection of methyl-metacrylate in osteoporosis and severe vertebral osteolysis (Galibert's technic)]. , 1989, Annales de chirurgie.

[24]  Y. Tsuji,et al.  Barium granuloma involving urinary bladder. , 1989, Urologia internationalis.