The potential of portland cement for use in spinal surgery: literature review

Jackson Payne-Dearberg; Behzad Eftekhar

doi:10.1016/j.inat.2023.101855

The potential of portland cement for use in spinal surgery: literature review

Jackson Payne-Dearberg, Behzad Eftekhar^*

^*Corresponding author for this work

Macquarie Medical School

Research output: Contribution to journal › Review article › peer-review

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Abstract

Background: Recent systematic reviews demonstrate good efficacy of vertebroplasty (VP), however adverse outcomes including re-collapse of augmented vertebrae, cement leakage, adjacent vertebral column fractures, venous thrombosis, lack of cement bioactivity and high exothermic reactions represent major limitations of VP. Polymethyl methacrylate (PMMA), the current gold standard cement used in VP has been implicated in several adverse outcomes. Portland Cement (PC) is widely available, inexpensive and is the main component of Mineral Trioxide Aggregate (MTA), which is used extensively in endodontics and is approved for use in humans. Objectives: Summarise literature to determine the safety of PC use in humans and compare the physical properties of PC to PMMA to determine the potential for use of PC in spinal surgery including VP. Methods: Literature review of Medline and Cochrane to July 2021. Search strategy included terms surrounding vertebroplasty, Portland Cement, PMMA, bone cements and materials testing. Citation chaining was used. Results: PC has lower exothermic reaction, less toxicity and better bioactivity than PMMA. Strength and stiffness of PC are both lower than PMMA, closer to properties of natural bone, which could provide benefit following VP. Long setting time, poor injectability and radiolucency represent limitations of PC, but there are studies showing that these limitations can be overcome through inclusion of additives. Conclusion: PC has potential for use in spinal surgery including VP and reinforcement of pedicle screws with wider surgical indications in developing countries. However, further research pertaining to improvement of setting time and injectability is required.

Original language	English
Article number	101855
Pages (from-to)	1-5
Number of pages	5
Journal	Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
Volume	34
DOIs	https://doi.org/10.1016/j.inat.2023.101855
Publication status	Published - Dec 2023

Bibliographical note

Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

Keywords

Fusion
Reinforcement of pedicle screw
Spinal surgery
Spine
Vertebroplasty

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title = "The potential of portland cement for use in spinal surgery: literature review",

abstract = "Background: Recent systematic reviews demonstrate good efficacy of vertebroplasty (VP), however adverse outcomes including re-collapse of augmented vertebrae, cement leakage, adjacent vertebral column fractures, venous thrombosis, lack of cement bioactivity and high exothermic reactions represent major limitations of VP. Polymethyl methacrylate (PMMA), the current gold standard cement used in VP has been implicated in several adverse outcomes. Portland Cement (PC) is widely available, inexpensive and is the main component of Mineral Trioxide Aggregate (MTA), which is used extensively in endodontics and is approved for use in humans. Objectives: Summarise literature to determine the safety of PC use in humans and compare the physical properties of PC to PMMA to determine the potential for use of PC in spinal surgery including VP. Methods: Literature review of Medline and Cochrane to July 2021. Search strategy included terms surrounding vertebroplasty, Portland Cement, PMMA, bone cements and materials testing. Citation chaining was used. Results: PC has lower exothermic reaction, less toxicity and better bioactivity than PMMA. Strength and stiffness of PC are both lower than PMMA, closer to properties of natural bone, which could provide benefit following VP. Long setting time, poor injectability and radiolucency represent limitations of PC, but there are studies showing that these limitations can be overcome through inclusion of additives. Conclusion: PC has potential for use in spinal surgery including VP and reinforcement of pedicle screws with wider surgical indications in developing countries. However, further research pertaining to improvement of setting time and injectability is required.",

keywords = "Fusion, Reinforcement of pedicle screw, Spinal surgery, Spine, Vertebroplasty",

author = "Jackson Payne-Dearberg and Behzad Eftekhar",

note = "Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.",

year = "2023",

month = dec,

doi = "10.1016/j.inat.2023.101855",

language = "English",

volume = "34",

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journal = "Interdisciplinary Neurosurgery: Advanced Techniques and Case Management",

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T1 - The potential of portland cement for use in spinal surgery

T2 - literature review

AU - Payne-Dearberg, Jackson

AU - Eftekhar, Behzad

N1 - Copyright the Author(s) 2023. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

PY - 2023/12

Y1 - 2023/12

N2 - Background: Recent systematic reviews demonstrate good efficacy of vertebroplasty (VP), however adverse outcomes including re-collapse of augmented vertebrae, cement leakage, adjacent vertebral column fractures, venous thrombosis, lack of cement bioactivity and high exothermic reactions represent major limitations of VP. Polymethyl methacrylate (PMMA), the current gold standard cement used in VP has been implicated in several adverse outcomes. Portland Cement (PC) is widely available, inexpensive and is the main component of Mineral Trioxide Aggregate (MTA), which is used extensively in endodontics and is approved for use in humans. Objectives: Summarise literature to determine the safety of PC use in humans and compare the physical properties of PC to PMMA to determine the potential for use of PC in spinal surgery including VP. Methods: Literature review of Medline and Cochrane to July 2021. Search strategy included terms surrounding vertebroplasty, Portland Cement, PMMA, bone cements and materials testing. Citation chaining was used. Results: PC has lower exothermic reaction, less toxicity and better bioactivity than PMMA. Strength and stiffness of PC are both lower than PMMA, closer to properties of natural bone, which could provide benefit following VP. Long setting time, poor injectability and radiolucency represent limitations of PC, but there are studies showing that these limitations can be overcome through inclusion of additives. Conclusion: PC has potential for use in spinal surgery including VP and reinforcement of pedicle screws with wider surgical indications in developing countries. However, further research pertaining to improvement of setting time and injectability is required.

AB - Background: Recent systematic reviews demonstrate good efficacy of vertebroplasty (VP), however adverse outcomes including re-collapse of augmented vertebrae, cement leakage, adjacent vertebral column fractures, venous thrombosis, lack of cement bioactivity and high exothermic reactions represent major limitations of VP. Polymethyl methacrylate (PMMA), the current gold standard cement used in VP has been implicated in several adverse outcomes. Portland Cement (PC) is widely available, inexpensive and is the main component of Mineral Trioxide Aggregate (MTA), which is used extensively in endodontics and is approved for use in humans. Objectives: Summarise literature to determine the safety of PC use in humans and compare the physical properties of PC to PMMA to determine the potential for use of PC in spinal surgery including VP. Methods: Literature review of Medline and Cochrane to July 2021. Search strategy included terms surrounding vertebroplasty, Portland Cement, PMMA, bone cements and materials testing. Citation chaining was used. Results: PC has lower exothermic reaction, less toxicity and better bioactivity than PMMA. Strength and stiffness of PC are both lower than PMMA, closer to properties of natural bone, which could provide benefit following VP. Long setting time, poor injectability and radiolucency represent limitations of PC, but there are studies showing that these limitations can be overcome through inclusion of additives. Conclusion: PC has potential for use in spinal surgery including VP and reinforcement of pedicle screws with wider surgical indications in developing countries. However, further research pertaining to improvement of setting time and injectability is required.

KW - Fusion

KW - Reinforcement of pedicle screw

KW - Spinal surgery

KW - Spine

KW - Vertebroplasty

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M1 - 101855

ER -

The potential of portland cement for use in spinal surgery: literature review

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