Percutaneous Expandable Bone Allograft Containment Device in the Treatment of Compression Fractures: An 18-year Single-surgeon Experience

Introduction: Surgical interventions to treat vertebral compression fractures (VCF) include vertebroplasty and kyphoplasty, which utilize the synthetic polymer polymethylmethacrylate (PMMA). Complications from PMMA include cement leakage into the venous system or spinal canal along with the risk of adjacent segment fractures (ASF) reported between 3-52%. Spineology’s Optimesh® system is a novel percutaneous polyethylene expandable containment mesh that is filled with morselized allograft bone. When applied to compression fracture repair, this technique can eliminate concerns of extravasation while allowing for biological repair of VCF’s. Currently, there are only a few case reports of VCF patients treated successfully with this modality.

Methods: A retrospective chart review will be conducted of 100-200 patients from 07/2004-07/2022 who underwent surgical intervention with the Optimesh® system to treat osteoporotic compression fractures. Clinical data from these charts will include DEXA scores, clinical outcome (using the ODOM scale), and peri- and post-operative complications. Pre- and post-operative radiographs will be reviewed to assess maintenance of height restoration during the follow-up period.

Results: Initial two-year experience of 40 patients (DEXA T-score mean: -2.9) showed that the Optimesh® system provided similar clinical results compared with kyphoplasty and vertebroplasty. Good-to-excellent clinical outcomes were reported by 90% of patients. Early experience complication rate was ~7% and included infection (n=1), further symptomatic delayed collapse (n=1) of the treated segment, pneumothorax (n=1), and hemothorax (n=1). The incidence of ASF within 6 months of the index procedure was 4.5%. We expect similar results based on this data.

Conclusion : When compared to non-biologic treatments, biologic vertebral reconstruction with Optimesh® seemingly provides equivalent pain relief and return to mobility. Our experience also demonstrates a lower rate of ASF than non-biologic alternatives. Finally, as a completely contained treatment option eliminating concerns for extravasation, the Optimesh® system has been employed in managing more complex compression fracture patterns where the vertebrae’s cortex is violated.