Journal Article

Biomaterial Injection under Local Anesthesia in a Case of Vertebral Compression Fracture (VCF)

Kapetanos, M, Lykomitros, V, Konstandinidis, A, Potoupnis, G, Anagnostidis, K

2007

Overview

Introduction: Injection of PMMA cement for kyphoplasty treatment of osteoporotic VCF's is widely accepted. However, there is scepticism for acute traumatic fractures for young patients due to long term PMMA adverse effects. Methods: This is a case report of a 32 year old male working in a heavy job. He had a traumatic VCF, type A1, Frankel E. The patient reported back pain (V.A.S. score 85). Under local anaesthesia, kyphoplasty procedure was performed using a novel synthetic in-jectable bone graft substitute composed of calcium sulphate and beta -tricalcium phosphate (Genex, Biocomposites Ltd. UK). Results: Next day the patient had significant pain improvement (VAS 35) and was fully mobilised. He was discharged and rested at home. After 4 weeks he returned to work. At the three months evaluation he had no deterioration of pain or deformity (local angulation). Conclusions: The use of PMMA cement is the major disadvantage of kyphoplasty because of (1) difference in strength compared to neighbouring osteoporotic bone, (2) high exothermic reaction (85 degree C), and (3) cement debris. We used Genex, a synthetic, radio-opaque bone graft, presented as an injectable setting paste (10 min) which is resorbed in approximately 8 to 12 months. Its use prevents long term problems of PMMA cement debris, it exhibits a low exothermic reaction (max temperature 37 degree C) and was strong enough to prevent deformity. We believe Genex warrants further study as a bone substitute for VCF kyphoplasty.