Finite element modelling of thermal damage to tissue by curing bone cement in vertebroplasty

Abstract

Vertebroplasty is a surgical technique in which a collapsed or collapsing vertebra is injected with bone cement in order to stabilize the vertebra and/or prevent further collapse. Vertebral collapse most commonly occurs in osteoporotic vertebral bodies and may lead to loss of height or other spinal deformity, pain and occasionally neurological complications. The principal aim of the vertebroplasty procedure is pain relief, although an alternative technique which also uses bone cement, kyphoplasty, also aims to reverse deformity. The main advantages of vertebroplasty are that it can be carried out by injection of the cement into the vertebra through the skin, which is less traumatic for the patient than alternative treatments which may involve open surgery, and that it can be performed as an outpatient procedure which results in low cost. Early reports suggest that the technique is successful, most studies reporting pain relief in 67-100% of patients, although length of follow-up is currently relatively short [1]. Although the cement clearly plays a structural role, the effects of the cement curing process are not fully understood. It has been proposed that heat generation during cement polymerization may destroy pain receptors within the vertebral body, contributing to the pain relieving effect of the procedure. On the other hand, some surgeons have expressed concern that excessive heat generation may lead to damage to the spinal cord or nerve roots as they exit the vertebral column. The aims of this study, therefore, were to implement a finite element (FE) model of the cement curing process and to use the model to assess temperature histories of tissue surrounding a bolus of cement curing within a vertebral body.

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