J Korean Soc Spine Surg.  2007 Dec;14(4):235-242.

Kyphoplasty with Calcium Phosphate Cement (Calcibon(R)) in Osteoporotic Vertebral Fracture

• Kim EH
• Shin DH
• Nho JW
• Ryu KH

Abstract

STUDY DESIGN: A retrospective study
OBJECTIVES
We analyzed clinical and radiological results to verify the efficacy of calcium phosphate cement in kyphoplasty for treatment of osteoporotic vertebral fracture. SUMMARY AND LITERATURE REVIEW: Calcium phosphate is a biocompatible alternative to PMMA for vertebral augmentation in painful osteoporotic vertebral fracture as it is osteoconductive, non-exothermic, and injectable.
MATERIALS AND METHODS
We analyzed 45 cases treated from April 2005 to August 2006 with a minimum of 1 year follow-up. Preoperative and post operative pain scores (visual analogue scale), ambulatory status, and patient satisfaction were measured. Anterior vertebral height, as well as the status and size of cement were assessed radiologically preoperatively, postoperatively, and at 3 months and 1 year.
RESULTS
Pain scores (visual analogue scale) and ambulatory status improved significantly after kyphoplasty and remained unchanged during follow-up. Overall patient satisfaction was 93%. Radiological findings showed that mean vertebral height was significantly higher than preoperative (p<0.05). According to follow-up radiological finding, we divided cases into 4 groups: Group 1, 2; maintained vertebral height with minimal or some cement resorption; Group 3, 4; cement crack resorption and vertebral collapse. Group 1, 2 and Group 3, 4 had 38 patients (84%) and 7 patients(16%) respectively. Revision surgery was needed in 3 cases (antero-posterior surgery in 2 cases of group 4, and decompression in 1 case of extravasation into the neural canal).
CONCLUSIONS
Kyphoplasty with calcium phosphate may be a good alternative for treatment of osteoporotic vertebral fracture, but non-union of the vertebral body with a large cleft showed a high risk of premature resorption and collapse of the vertebral body. The presumed advantage over PMMA needs longer follow-up.

Keyword

Osteoporotic vertebral fracture; Calcium-Phosphate cement; Kyphoplasty

MeSH Terms

Calcium*
Decompression
Follow-Up Studies
Humans
Kyphoplasty*
Patient Satisfaction
Polymethyl Methacrylate
Retrospective Studies
Calcium
Polymethyl Methacrylate

Figure

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  Fig. 1. Final compressive stength determined in vitro after setting, is 60 Mpa and its compressive strength 6 hours after application is 25 Mpa which is equivalent that of healthy spongy bone. Setting reaction to final strength takes 72 hours.

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  Fig. 2. Mean VAS pain scores in which 0 indicate no pain, and 10 indicates severe pain. Compaired with preoperative scores, there was significant pain relief (P<0.05) at postoperative points.

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  Fig. 3. Compaired with preoperative result, the ability to move independently and ease of ambulation significantly improved(P<0.05) at postoperative point.

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  Fig. 4. Anterior vertebral body height measurement was obtained from lateral radiographs for fractured and adjacent unfractured control vertebrae. Mean vertebral height was significantly higher than preoperative (P<0.05) but regained height was unsignificantly lost (P>0.05) at postoperative interval.

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  Fig. 5. According to followup X-ray and CT scan, the case was divided into 4 group (A) Group 1 shows maintained vertebral height with minimal resorpton of cement. (B) Group 2 shows maintained vertebral height with some resorption of cement. (C) Group 3 shows cement crack resorption and moderated vertebral collapse. (D) Group 4 shows cement crack resorption, cement migration and marked collapse.

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  Fig. 6. (Group 1+Group 2) 38 patient(84%) showed good maintenance of vertebral height with minimal resorption of calcibone cement

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  Fig. 7. Histologic finding of retrieved cement showed calcibone particles mixed with fibrous tissue. Some osteoblastic reaming was noted suggesting osteointegration process.

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