Neurosurgery

Balloon Kyphoplasty by Stephan Becker, Michael Ogon

By Stephan Becker, Michael Ogon

This can be the 1st e-book to hide minimal-invasive remedy of osteoporotic, tumorous and demanding vertebral fractures within the English language. as well as particular descriptions of the options, together with assistance and methods from specialists, the publication features a bankruptcy concerning the clinical remedy of osteoporosis, that is necessary within the interdisciplinary method of osteoporosis. This acclaimed cutting edge notion unites a number of therapy features. extra conservative therapy equipment also are provided during this paintings. All chapters replicate new advancements and scientific findings within the box of orthopaedics, surgical procedure, traumatology and neurosurgery.

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Sample text

The intravertebral pressure can be further subdivided into (a) the pressure required to infiltrate the trabecular cavities with cement, and (b) the shell pressure as hydrostatic resistance caused by the displacement of the bone marrow out of the vertebra into the adjacent structure. The hydrostatic resistance strongly depends on the trabecular structure and on the porosity of the vertebral shell. The revised mathematical representation is as follows: Pinj = Pextra + Pinf + Pkomp (II) where Pinf = infiltration pressure and Pkomp = shell pressure.

It has been suggested that cements could be adapted to more closely resemble the properties of bone as a possible solution to the risk of adjacent vertebral fractures. Young’s modulus and the ultimate strength can be decreased from normal cement values to match those of bone. Using computational models, Wilcox [2004] and Sun and Liebschner [2004] have both demonstrated that the excess loading on adjacent vertebrae can be altered through the use of less-stiff materials. The cement’s porosity can be increased by altering its composition through the addition of soluble fillers or other materials not currently in use.

The augmentation creates a pillar of cement that reduces flexibility of the endplate by inhibiting endplate bulge, thereby reducing flexibility of the entire motion segment. This decreased flexibility may cause loading to be redistributed, thereby increasing loading on adjacent vertebrae. These computational results thereby confirm part (b) of the biomechanical hypothesis; that is, the rigid pillar effect of the cement creates increased loading in adjacent vertebrae. Results obtained in the multisegment model suggest a mechanism responsible for the change in biomechanical loading leading to adjacent vertebral fractures: the pillar effect, outlined in the following steps: 1.

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