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Histopathologic Analysis of Human Vertebral Bodies After Vertebral Augmentation with Polymethylmethacrylate with Use of an Inflatable Bone TampA Case Report
Umasuthan Srikumaran, BA1; Wade Wong, DO2; Stephen M. Belkoff, PhD3; Edward F. McCarthy, MD1
1 Department of Pathology, Johns Hopkins Medical Institutions, 401 North Broadway, Baltimore, MD 21231. E-mail address for E.F. McCarthy: mccarthy@jhmi.edu
2 Department of Radiology, University of California-San Diego Medical Center, 9300 Campus Point Drive, La Jolla, CA 92037
3 Department of Orthopaedic Surgery, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, #A672, Baltimore, MD 21224
View Disclosures and Other Information
The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Departments of Pathology and Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, and the Department of Radiology, University of California-San Diego, San Diego, California

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Aug 01;87(8):1838-1843. doi: 10.2106/JBJS.D.02848
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Vertebroplasty, first described by Galibert et al.1 for the treatment of vertebral angiomas, is now often used to treat painful osteoporotic compression fractures of vertebral bodies and the pain associated with malignant tumor osteolysis2,3. Vertebral augmentation with percutaneous injection of polymethylmethacrylate cement after the use of an inflatable bone tamp is a variant of vertebroplasty that is commonly called kyphoplasty, a term that we will use hereafter. Inflation of the balloon tamp elevates the vertebral body end plates to reduce kyphosis4-6. Although infrequent, the complications of these procedures include leakage of cement into perispinal areas or the epidural space, embolization of cement, and spinal infection. Cement leakage is responsible for neurologic complications, including transient radiculopathies and spinal cord compression2,7,8. Thermal necrosis is a well-established consequence of cement-curing in conjunction with arthroplasty9-11, but the role of the exothermic polymerization of polymethylmethacrylate in vertebroplasty is unknown. Temperatures measured in an ex vivo study were sufficiently high for thermal necrosis to be considered a possibility12,13. The authors of a histopathologic study14 attributed a zone of necrosis around polymethylmethacrylate cement that had been injected into a metastatic vertebral tumor to thermal necrosis, but there may be other causes.
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