Research Article Kyphoplasty of Osteoporotic Fractured Vertebrae: A Finite Element Analysis about Two Types of Cement Carolin Meyer 1 , Kerstin van Gaalen 2 , Tim Leschinger 1 , Max J. Scheyerer 1 , Wolfram F. Neiss 3 , Manfred Staat 4 , Lars P. Müller 1 , and Kilian Wegmann 1 1 University Hospital of Cologne, Department of Orthopedics and Trauma Surgery, Kerpener Straße 62, 50937 Cologne, Germany 2 College of Biomedical Engineering, RWTH Aachen, Templergraben 55, 52056 Aachen, Germany 3 University of Cologne, Institute of Anatomy, Joseph-Stelzmann Str. 9, 50931 Cologne, Germany 4 University of Applied Science, FH Aachen, Heinrich-Mußmann Str. 1, 52428 J¨ ulich, Germany Correspondence should be addressed to Carolin Meyer; carolin.meyer@uk-koeln.de Received 13 January 2019; Accepted 9 April 2019; Published 22 April 2019 Academic Editor: Nicholas Dunne Copyright © 2019 Carolin Meyer et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. If conservative treatment of osteoporotic vertebral compression fractures fails, vertebro- or kyphoplasty is indicated. Usually, polymethylmethacrylate cement (PMMA) is applied coming along with many disadvantageous features. Aluminum-free glass- polyalkenoate cement (GPC) appears to be a beneft alternative material. Tis study aimed at comparing the mean stress values in human vertebrae afer kyphoplasty with PMMA and GPC (IlluminOss6) at hand of a fnite element analysis. Tree models were created performing kyphoplasty using PMMA or IlluminOss6, respectively, at two native, human lumbar vertebrae (L4) while one remains intact. Finite element analysis was performed using CT-scans of every vertebra. Moreover the PMMA-treated vertebra was used as a model as analyses were executed using material data of PMMA and of GPC. Te unimpaired, spongious bone showed potentials of 0.25 MPa maximally. Afer augmentation stress levels showed fvefold increase, rising from externally to internally, revealing stress peaks at the ventral border of the spinal canal. At central areas of cement 1 MPa is measured in both types of cement. Around these central areas the von Mises stress decreased about 25-50% (0.5-0.75 MPa). If workload of 500 N was applied, the stress appeared to be more centralized at the IlluminOss6-model, similar to the unimpaired. Considering the endplates the GPC model also closely resembles the unimpaired. Comparing the PMMA-treated vertebral body and the GPC-simulation, there is an obvious diference. While the PMMA-treated model showed a central stress peak of 5 MPa, the GPC-simulation of the same vertebral body presents lower stress of 1.2-2.5 MPa. Finite element analysis showed that IlluminOss6 (GPC), used in kyphoplasty of vertebral bodies, creates lower level stress and strain compared to standardly used PMMA, leading to lower stress concentrations on the cranial and caudal vertebral surface especially. GPC appears to own advantageous biological and clinical relevant features. 1. Introduction Osteoporosis related fractures of the spinal column lead to pain and functional limitations, or even resulting in confne- ment to bed [1]. Due to the commonly wedge-shaped collaps- ing pattern of osteoporotic vertebral compression fractures (VCF) imbalanced kyphosis may occur, leading to loss of sagittal balance, chronic pain, and potentially resulting in decreased lung capacity and gastro-intestinal dysfunction [2, 3]. Controversial discussion about the appropriate individual treatment of VCF persists [4]. According to the treatment guidelines of Anselmetti et al. surgical treatment should be performed, if conservative treatment fails [5]. If the vertebral body is already deformed, kyphoplasty aims at correction of the vertebral shape in order to reduce pain and disability and to restore sagittal balance [1, 4–7]. It is commonly known that, besides shape of the fractures, the elastic modulus of the fracture region and of the imple- mented bone cement are important variables infuencing short- and long-term outcome afer kyphoplasty [8]. Commonly, polymethylmethacrylate cement (PMMA) is applied to the vertebra at kyphoplasty, in order to support ver- tebral structure. PMMA however comes along with specifc disadvantageous characteristics. PMMA generates signifcant Hindawi BioMed Research International Volume 2019, Article ID 9232813, 7 pages https://doi.org/10.1155/2019/9232813