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Histopathologic findings of retrieved specimens of vertebroplasty with polymethylmethacrylate cement: case control
Kuo-Yuan Huang1, Jing-Jou Yan, Ruey-Mo Lin
1Department of Orthopedics, Institute of Clinical Medicine, National Cheng Kung University Medical Center, Taiwan.
Study Design:
Case control study.
Objective:
To investigate the histopathologic findings of 2 retrieved specimens from failed vertebroplasty with polymethylmethacrylate (PMMA) cement.
Summary Of Background Data:
Vertebroplasty using PMMA cement has been commonly used to treat debilitating back pain from compression fracture, angiomas, and metastatic cancer. However, there was concern about the unpredictable future results with PMMA cement. The histopathologic changes were rarely reported.
Methods:
There were 2 PMMA augmented and 3 nonaugmented fractured vertebral bodies retrieved for histopathologic study. Between the 2 groups, we compared the findings of bone necrosis, foreign body reaction, fibrotic wall formation, and neovascularization.
Results:
Bone necrosis was noted in the periphery of PMMA cement, which was surrounded by fibrotic tissues. In contrast, no fibrotic wall formation could be found in the nonaugmented control group. Foreign body reaction was only noted in PMMA augmented cases, and neovascularization was only noted in the control cases.
Conclusion:
PMMA cement might not be as bioinert as we considered. Therefore, the long-term safety of vertebroplasty should be further evaluated.
Insights
Polymethylmethacrylate (PMMA) cement used in vertebroplasty may cause adverse histopathologic changes, including bone necrosis and foreign body reactions. Further evaluation of long-term safety is recommended.
Area of Science:
- Orthopedic surgery
- Biomaterials science
- Histopathology
Background:
- Vertebroplasty with polymethylmethacrylate (PMMA) cement is a common treatment for vertebral compression fractures.
- Concerns exist regarding the long-term outcomes and biocompatibility of PMMA cement.
- Histopathologic changes associated with PMMA cement in vertebroplasty are infrequently reported.
Observation:
- A case control study compared histopathologic findings of 2 PMMA-augmented vertebral bodies with 3 nonaugmented controls.
- Key parameters assessed included bone necrosis, foreign body reaction, fibrotic wall formation, and neovascularization.
Findings:
- PMMA cement was associated with peripheral bone necrosis and surrounding fibrotic tissue.
- Foreign body reactions were observed exclusively in PMMA-augmented specimens.
- Fibrotic wall formation and neovascularization were absent in PMMA-augmented cases but present in controls.
Implications:
- The study suggests that PMMA cement may not be entirely bioinert.
- Findings highlight the need for further investigation into the long-term safety and biocompatibility of PMMA cement in vertebroplasty.
- These insights are crucial for refining surgical techniques and patient selection for vertebroplasty procedures.