High-viscosity bone cement for vertebral compression fractures: a prospective study on intravertebral diffusion and leakage of bone cement

Construction and clinical validation of risk model for predicting bone cement leakage after the surgical management of spinal metastases

This study aimed to comprehensively analyze the risk factors associated with bone cement leakage (LCK) during the surgical management of spinal metastases, construct a joint risk model for predictive assessment, and validate the clinical applicability of the risk model in an independent patient cohort. A retrospective analysis was conducted on patients who underwent surgery for spinal metastases between February 2022 and June 2023. Patients were divided into a non-LCK group (n=134) and an LCK group (n=86) based on the presence or absence of bone cement leakage after surgery. Additionally, a validation group was established, consisting of 21 patients with LCK and 65 patients without. Analysis focused on patient demographics, intraoperative parameters, LCK location, complications, pain management, and improvements in activities of daily living (ADL). Logistic regression, calibration curve, clinical impact curve (CIC) analysis, decision curve analysis (DCA) and receiver operating characteristic (ROC) analysis were used to assess the risk factors and construct a joint risk model. There were significant differences between the two groups in pathologic fracture, Tomita classification, posterior wall destruction, injected laterality, injected bone cement volume, radicular pain, pulmonary embolism, and medullary compression. Pathologic fracture, radicular pain, pulmonary embolism, and medullary compression were positively correlated with the occurrence of LCK, while Tomita classification, posterior wall destruction, injection laterality, and injected bone cement volume were negatively correlated with the occurrence of LCK. Pathological fracture, Tomita classification, posterior wall destruction, injected laterality, injected bone cement volume, and specific postoperative complications were identified as significant risk factors associated with LCK. The constructed joint risk model, incorporating these risk factors, demonstrated substantial predictive value, with an Area Under the Curve (AUC) of 0.885. Clinical validation in an independent patient cohort further confirmed the predictive power of the joint risk model, with an AUC of 0.846. This study underscores the multifactorial nature of LCK in surgical management of spinal metastases, providing valuable insights for risk assessment and management.

Translation of a spinal bone cement product from bench to bedside

Spinal acrylic bone cements (ABCs) are used clinically for percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) to treat osteoporotic vertebral compression fractures. Product translation of spinal ABC products followed the design control processes including design verification and validation. The bench to bedside translation of the first Chinese spinal ABC product (Alliment®, namely Alliment Cement) approved by National Medical Products Administration of China was investigated and another commercial product served as the control (Osteopal®V, namely Osteopal V Cement). Results of non-clinical bench performance verification tests of compression, bending and monomer release showed that the newly marketed Alliment Cement is similar to the Osteopal V Cement with properties of both meeting the criteria specified by standards. The Alliment Cement demonstrated good biocompatibility during the 26 weeks’ bone implantation test. Porcine cadaver validation tests further revealed that the Alliment Cement satisfied the needs for both PVP and PKP procedures. A post-approval, retrospective clinical investigation further demonstrated the safety and efficacy of the Alliment Cement, with a significant reduction of pain and the improved stability of the fractured vertebral bodies. A successful translation of biomaterial medical products needs close collaborations among academia, industry, healthcare professionals and regulatory agencies.

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Bench-to-bedside research of the first Chinese spinal acrylic bone cement product.

•Pre- & clinical investigations demonstrate the product's safety and efficacy.

•Translation of biomaterial medical products follows regulated processes.

Advances in the application of mesenchymal stem cells, exosomes, biomimetic materials, and 3D printing in osteoporosis treatment

Owing to an increase in the aging population, osteoporosis has become a severe public health concern, with a high prevalence among the elderly and postmenopausal adults. Osteoporosis-related fracture is a major cause of morbidity and mortality in elderly and postmenopausal adults, posing a considerable socioeconomic burden. However, existing treatments can only slow down the process of osteoporosis, reduce the risk of fractures, and repair fractures locally. Therefore, emerging methods for treating osteoporosis, such as mesenchymal stem cell transplantation, exosome-driving drug delivery systems, biomimetic materials, and 3D printing technology, have received increasing research attention, with significant progress. Mesenchymal stem cells (MSCs) are pluripotent stem cells that can differentiate into different types of functional cells. Exosomes play a key role in regulating cell microenvironments through paracrine mechanisms. Bionic materials and 3D printed scaffolds are beneficial for the reconstruction and repair of osteoporotic bones and osteoporosis-related fractures. Stem cells, exosomes, and biomimetic materials represent emerging technologies for osteoporosis treatment. This review summarizes the latest developments in these three aspects.