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Evaluation of Calcium Phosphate and Calcium Sulfate as Injectable Bone Cements in Sheep Vertebrae

Zhu, Xuesong MD; Chen, Xiaoqing MD, PhD; Chen, Chunmao MD; Wang, Genlin MD, PhD; Gu, Yong MD; Geng, Dechun MD; Mao, Haiqing MD; Zhang, Zhiming MD, PhD; Yang, Huilin MD, PhD

doi: 10.1097/BSD.0b013e3182213f57
Original Articles

Study Design An animal study.

Objective To compare the biomechanical and biometabolic properties between calcium phosphate (CaP), calcium sulfate (CaS), and polymethylmethacrylate (PMMA) as bone void fillers in a sheep model of lumbar vertebral defect.

Summary of Background Data PMMA is commonly used as a bone void filler in vertebroplasty and kyphoplasty. However, it has certain intrinsic limitations. CaP and CaS are considered as potential PMMA substitutes, but further in vivo evaluations of their biomechanical and biometabolic properties are needed before they can be recommended for clinical use in routine vertebroplasty and kyphoplasty procedures.

Methods Bone voids were experimentally created on lumbar vertebrae L2-L5 with L6 left intact as a normal control in 24 adult female sheep. The defect vertebrae L2-L5 in each of the animals were randomized to receive no filler augmentation (controls) or augmentation with CaP, CaS, or PMMA. Animals were killed after 2, 12, and 24 weeks of the bone filler augmentation, respectively. Vertebrae L2-L6 were collected and their biomechanical strength/stiffness, osseointegration activity, and biodegradability were evaluated.

Results At all 3 time points tested, the PMMA-augmented lumbar vertebra had the highest biomechanical strength and stiffness, followed by the intact vertebra L6. CaP and CaS significantly improved the strength as compared with the sham augmentation, but did not yet restore it to the normal level. Osteogenesis occurred at low levels in the empty vertebrae, in the CaP-augmented defect vertebrae at 12 and 24 weeks, and in the CaS-augmented vertebrae at 12 weeks, but at a substantially high level after 24 weeks of CaS augmentation. The filler biodegradation rate was low in the CaP-augmented vertebrae, but was substantially high in the CaS-augmented vertebrae.

Conclusions CaP and CaS are effective enough to strengthen the fractured lumbar vertebrae in a time-dependent manner, although not as good as PMMA. CaS has a much higher osseointegration capacity than CaP.

Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, PR China

Support sources include the Health Public Sector Special Fund of China (Grant No.200802152), the National Nature Science Foundation of China (Grant No.81071451), the Nature Science Foundation of Jiangsu Province (Grant No. ZR 2008019, BK2008008), and the Health Youth Foundation of Suzhou (Grant No.201005).

The authors declare no conflict of interest.

Reprints: Huilin Yang, MD, PhD, Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, 188 Shizi Road, Suzhou, 215006, PR China (e-mail:

Received September 13, 2010

Accepted April 18, 2011

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.