Trabecular Microstructure and Damage Affect Cement Leakage From the Basivertebral Foramen During Vertebral...

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Radiology

Background:

• Type B cement leakage through the basivertebral foramen (BF) is common in vertebral augmentation.
• The exact mechanisms, including trabecular bone orientation and fracture-related damage, remain unclear.

Purpose of the Study:

• To investigate the reasons for frequent cement leakage from the BF during vertebral augmentation.
• To understand the role of trabecular bone microstructure and injury in cement extravasation.

Main Methods:

• Analysis of 12 human lumbar spines (T12-L5) using micro-computed tomography (MicroCT) before and after simulated compression fractures.
• Evaluation of trabecular microstructure and intertrabecular space variations in different vertebral regions.
• Assessment of cement leakage after simulated vertebral augmentation.

Main Results:

• The middle vertebral region, containing the BF, exhibited lower trabecular bone parameters compared to superior and inferior regions.
• Compression fractures significantly increased intertrabecular distance in the middle region.
• Type B leakage was the predominant type observed, consistent with prior research.

Conclusions:

• The BF region is mechanically weakest due to sparse trabecular bone and susceptibility to damage during vertebral fractures.
• Trabecular injury in the middle vertebral region leads to increased intervertebral spacing, promoting Type B cement leakage.
• Findings elucidate specific mechanisms of BF cement leakage, highlighting the impact of trabecular microstructure and injury.