{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:27:56Z","timestamp":1789734476470,"version":"4.0.1"},"reference-count":45,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,3]],"date-time":"2023-07-03T00:00:00Z","timestamp":1688342400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Ministry of Science and Technology of Taiwan, ROC","award":["MOST 108-2622-B-010-006"],"award-info":[{"award-number":["MOST 108-2622-B-010-006"]}]},{"name":"Ministry of Science and Technology of Taiwan, ROC","award":["MOST 110-2622-B-A49-001"],"award-info":[{"award-number":["MOST 110-2622-B-A49-001"]}]},{"name":"Ministry of Science and Technology of Taiwan, ROC","award":["111-EC-17-A-19-S6-005"],"award-info":[{"award-number":["111-EC-17-A-19-S6-005"]}]},{"name":"Ministry of Economics of Taiwan, ROC","award":["MOST 108-2622-B-010-006"],"award-info":[{"award-number":["MOST 108-2622-B-010-006"]}]},{"name":"Ministry of Economics of Taiwan, ROC","award":["MOST 110-2622-B-A49-001"],"award-info":[{"award-number":["MOST 110-2622-B-A49-001"]}]},{"name":"Ministry of Economics of Taiwan, ROC","award":["111-EC-17-A-19-S6-005"],"award-info":[{"award-number":["111-EC-17-A-19-S6-005"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Osteoporosis-induced vertebral compression fracture (OVCF) occurs commonly in people over the age of 50, especially among menopausal women. Besides conservative therapy, minimally invasive percutaneous vertebroplasty (PVP) and kyphoplasty (PKP) have been widely used in clinical treatment and achieved good efficacy. However, the leakage of bone cement (CL) during vertebroplasty (PV) is a major risk that can cause (serious) complications such as compression of the spinal cord, pulmonary embolism, or even paraplegia. In this study, we introduced a new aspiration technique with standard PV procedures (APV) to ameliorate the risk of leakage with quantitative verifications of its effectiveness. APV intends to create a differential pressure to guide the direction of cement flow within the vertebrae. To test this technique, Nubian goats\u2019 ex vivo vertebral bodies (VBs) were used to simulate the PV surgical process in humans. Results show that the proposed APV has a lower leakage rate of 13% compared to the 53% of conventional PV. Additionally, the APV approach achieves more uniform cement distribution via the 9-score method with a value of 7 \u00b1 1.30 in contrast to 4 \u00b1 1.78 by conventional PV.<\/jats:p>","DOI":"10.3390\/bioengineering10070795","type":"journal-article","created":{"date-parts":[[2023,7,4]],"date-time":"2023-07-04T01:42:47Z","timestamp":1688434967000},"page":"795","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Impact of Aspiration Percutaneous Vertebroplasty in Reducing Bone Cement Leakage and Enhancing Distribution\u2014An Ex Vivo Study in Goat Vertebrae"],"prefix":"10.3390","volume":"10","author":[{"given":"Hsin-Tzu","family":"Lu","sequence":"first","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia-Yi","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu-Chuan","family":"Tsuei","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"},{"name":"Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yung-Fu","family":"Hsu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chung-Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shih-Hao","family":"Cheng","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"},{"name":"Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Chu","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Cheng Hsin General Hospital, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2730-7278","authenticated-orcid":false,"given":"Chuan","family":"Li","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9407-0741","authenticated-orcid":false,"given":"Woei-Chyn","family":"Chu","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, National Yang-Ming Chiao-Tung University, Taipei 11221, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"882241","DOI":"10.3389\/fendo.2022.882241","article-title":"The Global Burden of Osteoporosis, Low Bone Mass, and Its Related Fracture in 204 Countries and Territories, 1990-2019","volume":"13","author":"Shen","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Zhang, S., Guo, Q., Yang, Y., Feng, H., Zhao, Y., Guo, P., Li, D., Du, X., and Song, Q. (2023). Feasibility Study of 3D FACT and IVIM Sequences in the Evaluation of Female Osteoporosis. Bioengineering, 10.","DOI":"10.3390\/bioengineering10060710"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Gao, H., Huang, J., Wei, Q., and He, C. (2023). Advances in Animal Models for Studying Bone Fracture Healing. Bioengineering, 10.","DOI":"10.3390\/bioengineering10020201"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"46","DOI":"10.5152\/eurjrheum.2016.048","article-title":"An overview and management of osteoporosis","volume":"4","year":"2017","journal-title":"Eur. J. Rheumatol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3947368","DOI":"10.1155\/2020\/3947368","article-title":"Advances in Vertebral Augmentation Systems for Osteoporotic Vertebral Compression Fractures","volume":"2020","author":"Long","year":"2020","journal-title":"Pain Res. Manag."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"102779","DOI":"10.1016\/j.otsr.2020.102779","article-title":"Treatment of osteoporotic vertebral fractures","volume":"107","author":"Prost","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hsieh, M.K., Chen, W.J., Lee, M.S., Lin, S.Y., Liu, M.Y., Lee, D.M., and Tai, C.L. (2022). Biomechanical Evaluation of a Novel Expandable Vertebral Augmentation System Using Human Cadaveric Vertebrae. Appl. Sci., 12.","DOI":"10.3390\/app121910165"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Liao, J.C., Chen, M.J.W., Lin, T.Y., and Chen, W.P. (2021). Biomechanical comparison of vertebroplasty, kyphoplasty, vertebrae stent for osteoporotic vertebral compression fractures\u2014A finite element analysis. Appl. Sci., 11.","DOI":"10.21203\/rs.3.rs-490557\/v1"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"942195","DOI":"10.3389\/fsurg.2022.942195","article-title":"Treatment of Elderly Patients with Acute Symptomatic OVCF: A Study of Comparison of Conservative Treatment and Percutaneous Kyphoplasty","volume":"9","author":"Yu","year":"2022","journal-title":"Front. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s11657-019-0563-8","article-title":"Risk factors for conservative treatment failure in acute osteoporotic vertebral compression fractures (OVCFs)","volume":"14","author":"Zhang","year":"2019","journal-title":"Arch. Osteoporos."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Castro, A.P.G. (2021). Computational challenges in tissue engineering for the spine. Bioengineering, 8.","DOI":"10.3390\/bioengineering8020025"},{"key":"ref_12","first-page":"431","article-title":"Kyphoplastie und Vertebroplastie","volume":"5","author":"Reilmann","year":"2011","journal-title":"Der Unfallchirurg"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"386","DOI":"10.14444\/8050","article-title":"Special Considerations to Improve Clinical Outcomes in Patients with Osteoporosis Undergoing Spine Surgery","volume":"15","author":"Fiani","year":"2021","journal-title":"Int. J. Spine Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/s13018-018-0952-5","article-title":"Balloon kyphoplasty versus percutaneous vertebroplasty for osteoporotic vertebral compression fracture: A meta-analysis and systematic review","volume":"13","author":"Wang","year":"2018","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"861","DOI":"10.1177\/0284185117732599","article-title":"Clinical outcome and subsequent sequelae of cement extravasation after percutaneous kyphoplasty and vertebroplasty: A comparative review","volume":"59","author":"Semaan","year":"2018","journal-title":"Acta Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"633","DOI":"10.1016\/j.wneu.2017.01.124","article-title":"Risk factors for cement leakage after vertebroplasty or kyphoplasty: A meta-analysis of published evidence","volume":"101","author":"Zhan","year":"2017","journal-title":"World Neurosurg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Li, Z., Yu, K., Chang, X., Cai, S., Gao, J., and Wang, Y. (2020). Cement leakage following percutaneous kyphoplasty in a patient after a posterior lumbar fusion: A case report. BMC Surg., 20.","DOI":"10.1186\/s12893-020-00733-8"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1186\/s13018-019-1459-4","article-title":"Risk factors of neurological deficit and pulmonary cement embolism after percutaneous vertebroplasty","volume":"14","author":"Hsieh","year":"2019","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"372","DOI":"10.21037\/atm.2019.06.81","article-title":"Clinical characteristics and management of cardiac and\/or pulmonary cement embolus after percutaneous vertebroplasty: A single center experience","volume":"7","author":"Kong","year":"2019","journal-title":"Ann. Transl. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.injury.2012.10.017","article-title":"Decompressed percutaneous vertebroplasty: A secured bone cement delivery procedure for vertebral augmentation in osteoporotic compression fractures","volume":"44","author":"Chu","year":"2013","journal-title":"Injury"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e18217","DOI":"10.1097\/MD.0000000000018217","article-title":"The effect of bone cement distribution on clinical efficacy after percutaneous kyphoplasty for osteoporotic vertebral compression fractures","volume":"98","author":"He","year":"2019","journal-title":"Medicine"},{"key":"ref_22","first-page":"5176","article-title":"Percutaneous vertebral augmentation for osteoporotic vertebral compression fractures will increase the number of subsequent fractures at adjacent vertebral levels: A systematic review and meta-analysis","volume":"25","author":"Sun","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e408","DOI":"10.1016\/j.wneu.2018.11.181","article-title":"Cement distribution patterns in osteoporotic vertebral compression fractures with intravertebral cleft: Effect on therapeutic efficacy","volume":"123","author":"Yu","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Banstola, A., and Reynolds, J.N. (2022). The sheep as a large animal model for the investigation and treatment of human disorders. Biology, 11.","DOI":"10.3390\/biology11091251"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1007\/s10856-010-4191-5","article-title":"A novel sheep vertebral bone defect model for injectable bioactive vertebral augmentation materials","volume":"22","author":"Zhu","year":"2011","journal-title":"J. Mater. Sci. Mater. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"173","DOI":"10.3415\/VCOT-11-02-0026","article-title":"Development of an in vivo experimental model for percutaneous vertebroplasty in sheep","volume":"25","author":"Benneker","year":"2012","journal-title":"Vet. Comp. Orthop. Traumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"111","DOI":"10.21037\/jss.2016.06.05","article-title":"Effects of cement augmentation on the mechanical stability of multilevel spine after vertebral compression fracture","volume":"2","author":"Tan","year":"2016","journal-title":"J. Spine Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1007\/s00586-008-0701-2","article-title":"Balloon kyphoplasty in the treatment of metastatic disease of the spine: A 2-year prospective evaluation","volume":"17","author":"Pflugmacher","year":"2008","journal-title":"Eur. Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"16320","DOI":"10.1038\/s41598-020-73513-2","article-title":"A novel and convenient method to evaluate bone cement distribution following percutaneous vertebral augmentation","volume":"10","author":"Liu","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e677","DOI":"10.1016\/j.wneu.2018.03.050","article-title":"The optimal volume fraction in percutaneous vertebroplasty evaluated by pain relief, cement dispersion, and cement leakage: A prospective cohort study of 130 patients with painful osteoporotic vertebral compression fracture in the thoracolumbar vertebra","volume":"114","author":"Sun","year":"2018","journal-title":"World Neurosurg."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e1381","DOI":"10.1016\/j.wneu.2018.11.062","article-title":"Percutaneous vertebral augmentation for osteoporotic vertebral compression fracture in the midthoracic vertebrae (T5-8): A retrospective study of 101 patients with 111 fractured segments","volume":"122","author":"Liu","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"637","DOI":"10.15274\/INR-2014-10079","article-title":"Is intervertebral cement leakage a risk factor for new adjacent vertebral collapse?","volume":"20","author":"Churojana","year":"2014","journal-title":"Interv. Neuroradiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Liao, P.H., Tsuei, Y.C., and Chu, W. (2022). Application of Machine Learning in Developing Decision-Making Support Models for Decompressed Vertebroplasty. Healthcare, 10.","DOI":"10.3390\/healthcare10020214"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"E358","DOI":"10.1097\/BRS.0b013e31805c0b25","article-title":"Combined extraforaminal and intradiscal cement leakage following percutaneous vertebroplasty","volume":"32","author":"Chen","year":"2007","journal-title":"Spine"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"21514593221119625","DOI":"10.1177\/21514593221119625","article-title":"A Comparison of Percutaneous Kyphoplasty with High-Viscosity and Low-Viscosity Bone Cement for Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Study","volume":"13","author":"Wang","year":"2022","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e828","DOI":"10.1016\/j.wneu.2022.12.117","article-title":"Systematic Retrospective Analysis of Risk Factors and Preventive Measures of Bone Cement Leakage in Percutaneous Kyphoplasty","volume":"171","author":"Li","year":"2023","journal-title":"World Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"e20515","DOI":"10.1097\/MD.0000000000020515","article-title":"Efficacy and safety of high-viscosity cement in percutaneous vertebroplasty for treatment of Osteoporotic vertebral compression fractures: A retrospective cohort study","volume":"99","author":"Li","year":"2020","journal-title":"Medicine"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2680","DOI":"10.1007\/s00586-020-06636-9","article-title":"Comparison between vertebroplasty with high or low viscosity cement augmentation or kyphoplasty in cement leakage rate for patients with vertebral compression fracture: A systematic review and network meta-analysis","volume":"30","author":"Chen","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1721","DOI":"10.1016\/j.jvir.2011.08.021","article-title":"Percutaneous vertebroplasty for vertebral compression fractures with intravertebral cleft: Cement injection under vacuum aspiration","volume":"22","author":"Koike","year":"2011","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00256-020-03437-5","article-title":"Percutaneous vertebral augmentation using drill rotation for osteoporotic vertebral compression fractures with intravertebral vacuum cleft","volume":"49","author":"Li","year":"2020","journal-title":"Skelet. Radiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1177\/2192568218803106","article-title":"Vertebral body lavage reduces hemodynamic response to vertebral body augmentation with PMMA","volume":"9","author":"Albers","year":"2019","journal-title":"Glob. Spine J."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Piechowiak, E.I., Isalberti, M., Pileggi, M., Distefano, D., Hirsch, J.A., and Cianfoni, A. (2019). Mechanical cavity creation with curettage and vacuum suction (Q-VAC) in lytic vertebral body lesions with posterior wall dehiscence and epidural mass before cement augmentation. Medicina, 55.","DOI":"10.3390\/medicina55100633"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1186\/s13018-020-01779-3","article-title":"Effect of unilateral pulsed jet lavage prior to vertebroplasty on the intravertebral pressure and cement distribution","volume":"15","author":"Yan","year":"2020","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Li, Q., Long, X., Wang, Y., Guan, T., Fang, X., Guo, D., Lv, J., Hu, X., Jiang, X., and Cai, L. (2021). Clinical observation of two bone cement distribution modes after percutaneous vertebroplasty for osteoporotic vertebral compression fractures. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04480-6"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1272","DOI":"10.1007\/s00586-011-1744-3","article-title":"Comparison of unipedicular and bipedicular kyphoplasty on the stiffness and biomechanical balance of compression fractured vertebrae","volume":"20","author":"Chen","year":"2011","journal-title":"Eur. Spine J."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/7\/795\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:05:03Z","timestamp":1760126703000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/10\/7\/795"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,3]]},"references-count":45,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["bioengineering10070795"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering10070795","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,3]]}}}