Evaluation of an injectable hydrogel and polymethyl methacrylate in restoring mechanics to compressively fractured spine motion segments.

ABSTRACT

BACKGROUND CONTEXT Compressive fracture can produce profound changes to the mechanical profile of a spine segment. Minimally invasive repair has the potential to restore both function and structural integrity to an injured spine. Use of both hydrogels to address changes to the disc, combined with polymethyl methacrylate (PMMA) to address changes to the vertebral body, has the potential to facilitate repair. PURPOSE: The purpose of this investigation was to determine if the combined use of hydrogel injection and PMMA could restore the mechanical profile of an axially injured spinal motion segment. STUDY DESIGN: This is a basic science study evaluating a combination of hydrogel injection and vertebroplasty on restoring mechanics to compressively injured porcine spine motion segments. METHODS: Fourteen porcine spine motion segments were subject to axial compression until fracture using a dynamic servohydraulic testing apparatus. Rotational and compressive stiffness was measured for each specimen under the following conditions initial undamaged, fractured, fatigue loading under compression, hydrogel injection, PMMA injection, and fatigue loading under compression. Group 1 received hydrogel injection followed by PMMA injection, whereas Group 2 received PMMA injection followed by hydrogel injection. This study was funded under a Natural Sciences and Engineering Research Council of Canada discovery grant. RESULTS: PMMA injection was found to alter the compressive stiffness properties of axially injured spine motion segments, restoring values from Groups 1 and 2 to 89.3%±29.3% and 81%±27.9% of initial values respectively. Hydrogel injection was found to alter the rotational stiffness properties, restoring specimens in Groups 1 and 2 to 151.5%±81% and 177.2%±54.9% of initial values respectively. Prolonged restoration of function was not possible, however, after further fatigue loading. CONCLUSIONS: Using this repair technique, replication of the mechanism of injury appears to cause a rapid deterioration in function of the motion segments. Containment of the hydrogel appears to be an issue with large breaches in the end plate, as it is posited to migrate into the cancellous bone of the vertebral body. Future work should attempt to evaluate methods in fully sealing the disc space.