• Sang-Youn Song, Sung Wook Kang, Seong Hee Cho, Se-Joon Heo, Min Goo Cho, Young-Jin Park, Se Heang Oh, Gu-Hee Jung, and Dong-Hee Kim.
• Department of Orthopaedic Surgery, Institute of Health Science, Research Institute of Clinical Medicine, Gyeongsang National University School of Medicine and Hospital, Jinju, Republic of Korea.
• World Neurosurg. 2022 Jun 1; 162: e73-e85.

ObjectiveKyphoplasty (KP) is a surgery used to reduce pain and increase stability by injecting medical bone cement into broken vertebrae. The purpose of this study was to determine the ideal amount of cement and injection site by analyzing forces with the finite element method.MethodsWe modeled the anatomical structure of the vertebra and injected the cement at T12. By increasing the amount of cement from 1 cc to 22 cc, stress applied to T11 and L1 cortical was calculated. In addition, stress applied to the adjacent KP level was calculated with different injection sites (medial, anterosuperior, posterosuperior, anteroinferior, and posteroinferior). After 5 cc cement was inserted, adjacent end plate stress was analyzed.ResultsIn this study, break point adjacent bone stress according to the capacity of cement was bimodal. Flexion/extension and lateral bending conditions showed similar break points (11.5-11.7 cc and 18.5-18.6 cc, respectively). When cement injection was changed, front under and back under had the highest stress values among various parts, whereas the center position showed the lowest stress value.ConclusionsWith increasing amount of bone cement, stress on the upper and lower end plates of the cemented segment increased significantly. Thus, increasing cement amount to be more than 11.5 cc has a potential risk of adjacent fracture. Centrally injected bone cement can lower the risk of adjacent fracture after percutaneous KP.Copyright © 2022 Elsevier Inc. All rights reserved.

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