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review of vertebroplasty cements

Percutaneous Vertebroplasty: Indications, Advantages and Drawbacks of Different Cements

Afshin Gangi MD, PhD. Jean-Pierre Imbert MD. Stephane Guth MD. Horia Marin MD. Lisa Wong. Catherine Roy MD.

Department of Radiology University Louis Pasteur Strasbourg 

A special note of gratitude goes to Stephen Ferron, Irving Freedmann and Petra Gangi for checking the presentation


Abstract: Polymethyl methacrylate (PMMA) is the most used cement in vertebroplasty. The new PMMA vertebroplasty cements had resolved the insufficient radiopacity but it needs always a hand mixing. The biocompatibility of PMMA with its exothermic effect is the major drawback (fibrous tissue layer between cement and bone). Another synthetic cement Cortoss® (Orthovitha, Malvern, USA) is developed for vertebroplasty. Its mix-on-demand delivery system allows direct injection of the cement and sets a lower exotherm than standard PMMA. The disadvantages are: less viscous than PMMA (risk of leakage), faster polymerization, and the cost. The Calcium Phosphate Bone Substitute Norian® SRS resorbs via normal cellular remodeling, and maintains strength during remodeling. Norian is very difficult to inject in the vertebrae and the radio opacity is not sufficient. A new calcium phosphate cement, Calcibon®, should be used in percutaneous vertebroplasty because of its better radiopacity. PMMA is cost effective, but its major drawback is the biocompatibility and its exothermic effect particularly criticize in osteoporosis. The Cortoss® seems to be promising in vertebroplasty particularly in osteoporotic patients. The indications of the most expensive cements,calcium phosphate cements, are limited to the vertebroplasty ( and sometimes kyphoplasty) of the recent burst fractures.