{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T06:11:29Z","timestamp":1787983889246,"version":"build-2784847793"},"reference-count":47,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T00:00:00Z","timestamp":1643932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100014419","name":"EIT Health","doi-asserted-by":"publisher","award":["20519"],"award-info":[{"award-number":["20519"]}],"id":[{"id":"10.13039\/100014419","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFB"],"abstract":"<jats:p>Cement discoplasty has been developed to treat patients with advanced intervertebral disc degeneration. In discoplasty, poly(methylmethacrylate) (PMMA) bone cement is injected into the disc, leading to reduced pain and certain spinal alignment correction. Standard PMMA-cements have much higher elastic modulus than the surrounding vertebral bone, which may lead to a propensity for adjacent fractures. A PMMA-cement with lower modulus might be biomechanically beneficial. In this study, PMMA-cements with lower modulus were obtained using previously established methods. A commercial PMMA-cement (V-steady\u00ae, G21 srl) was used as control, and as base cement. The low-modulus PMMA-cements were modified by 12 vol% (LA12), 16 vol% (LA16) and 20 vol% (LA20) linoleic acid (LA). After storage in 37 \u00b0C PBS from 24 h up to 8 weeks, specimens were tested in compression to obtain the material properties. A lower E-modulus was obtained with increasing amount of LA. However, with storage time, the E-modulus increased. Standard and low-modulus PMMA discoplasty were compared in a previously developed and validated computational lumbar spine model. All discoplasty models showed the same trend, namely a substantial reduction in range of motion (ROM), compared to the healthy model. The V-steady model had the largest ROM-reduction (77%), and the LA20 model had the smallest (45%). The average stress at the endplate was higher for all discoplasty models than for the healthy model, but the stresses were reduced for cements with higher amounts of LA. The study indicates that low-modulus PMMA is promising for discoplasty from a mechanical viewpoint. However, validation experiments are needed, and the clinical setting needs to be further considered.<\/jats:p>","DOI":"10.3390\/jfb13010018","type":"journal-article","created":{"date-parts":[[2022,2,4]],"date-time":"2022-02-04T11:35:17Z","timestamp":1643974517000},"page":"18","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Low-Modulus PMMA Has the Potential to Reduce Stresses on Endplates after Cement Discoplasty"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8967-7015","authenticated-orcid":false,"given":"Susanne","family":"Lewin","sequence":"first","affiliation":[{"name":"Department of Materials Science and Engineering, Division of Biomedical Engineering, Uppsala University, 751 21 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"F\u00f6rsth","sequence":"additional","affiliation":[{"name":"Department of Surgical Sciences, Division of Orthopedics, Uppsala University, 751 85 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6663-6536","authenticated-orcid":false,"given":"Cecilia","family":"Persson","sequence":"additional","affiliation":[{"name":"Department of Materials Science and Engineering, Division of Biomedical Engineering, Uppsala University, 751 21 Uppsala, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.joca.2013.10.019","article-title":"Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: The Wakayama Spine Study","volume":"22","author":"Teraguchi","year":"2014","journal-title":"Osteoarthr. Cartil."},{"key":"ref_2","first-page":"3","article-title":"Lumbar disc degeneration: Epidemiology and genetics","volume":"88","author":"Videman","year":"2006","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1001\/jama.2010.338","article-title":"Trends, Major Medical Complications, and Charges Associated With Surgery for Lumbar Spinal Stenosis in Older Adults","volume":"303","author":"Deyo","year":"2010","journal-title":"JAMA"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00132-014-3060-1","article-title":"Experiences with PMMA cement as a stand-alone intervertebral spacer","volume":"44","author":"Varga","year":"2015","journal-title":"Der Orthop\u00e4de"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"872","DOI":"10.1097\/BRS.0000000000001524","article-title":"Targeted therapy for low back pain in elderly degenerative lumbar scoliosis: A cohort study","volume":"41","author":"Yamada","year":"2016","journal-title":"Spine"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1007\/s00586-018-5547-7","article-title":"Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients","volume":"30","author":"Sola","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1177\/2192568219873885","article-title":"Percutaneous Cement Discoplasty for the Treatment of Advanced Degenerative Disc Conditions: A Case Series Analysis","volume":"10","author":"Willhuber","year":"2020","journal-title":"Glob. Spine J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1007\/s00586-019-05966-7","article-title":"Indirect foraminal decompression and improvement in the lumbar alignment after percutaneous cement discoplasty","volume":"28","author":"Kiss","year":"2019","journal-title":"Eur. Spine J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1007\/s00586-021-06805-4","article-title":"Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis","volume":"30","author":"Yamada","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"885","DOI":"10.1097\/BRS.0000000000001315","article-title":"Bone Marrow Edema and Low Back Pain in Elderly Degenerative Lumbar Scoliosis: A Cross-Sectional Study","volume":"41","author":"Nakamae","year":"2016","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1958","DOI":"10.1097\/BRS.0b013e31825bfb85","article-title":"Prevalence of Vertebral Endplate Modic Changes in Degenerative Lumbar Scoliosis and Its Associated Factors Analysis","volume":"37","author":"Wu","year":"2012","journal-title":"Spine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/j.clinbiomech.2005.10.001","article-title":"An exploratory study of loading and morphometric factors associated with specific failure modes in fatigue testing of lumbar motion segments","volume":"21","author":"Gallagher","year":"2006","journal-title":"Clin. Biomech."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1007\/BF02221591","article-title":"A comprehensive classification of thoracic and lumbar injuries","volume":"3","author":"Magerl","year":"1994","journal-title":"Eur. Spine J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1621","DOI":"10.1007\/s00586-009-1036-3","article-title":"The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation","volume":"18","author":"Abbushi","year":"2009","journal-title":"Eur. Spine J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.medengphy.2020.07.024","article-title":"Testing the impact of discoplasty on the biomechanics of the intervertebral disc with simulated degeneration: An in vitro study","volume":"84","author":"Techens","year":"2020","journal-title":"Med. Eng. Phys."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1016\/S0021-9290(03)00071-X","article-title":"Trabecular bone modulus\u2013density relationships depend on anatomic site","volume":"36","author":"Morgan","year":"2003","journal-title":"J. Biomech."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1007\/s00223-008-9174-x","article-title":"Bone Volume Fraction Explains the Variation in Strength and Stiffness of Cancellous Bone Affected by Metastatic Cancer and Osteoporosis","volume":"83","author":"Nazarian","year":"2008","journal-title":"Calcif. Tissue Int."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/S8756-3282(03)00210-2","article-title":"Finite element models predict in vitro vertebral body compressive strength better than quantitative computed tomography","volume":"33","author":"Crawford","year":"2003","journal-title":"Bone"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.clinbiomech.2007.08.024","article-title":"Mathematical relationships between bone density and mechanical properties: A literature review","volume":"23","author":"Helgason","year":"2008","journal-title":"Clin. Biomech. Bristol. Avon."},{"key":"ref_20","unstructured":"Persson, C., and Lopez, A.U.S. (2021, December 18). Cl, (71), Acrylic Cements for Bone Augmentation. Applicant: INOSSIA AB, Stockholm (SE), (2000) 42. Available online: https:\/\/worldwide.espacenet.com\/patent\/search\/family\/051689845\/publication\/WO2014168565A1?q=pn%3DPL2983725T3."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.jmbbm.2014.01.002","article-title":"Compressive mechanical properties and cytocompatibility of bone-compliant, linoleic acid-modified bone cement in a bovine model","volume":"32","author":"Mestres","year":"2014","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.actbio.2018.03.014","article-title":"In vivo response to a low-modulus PMMA bone cement in an ovine model","volume":"72","author":"Robo","year":"2018","journal-title":"Acta Biomater."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Robo, C., Wenner, D., Ubhayasekera, S.J.K.A., Hilborn, J., \u00d6hman-M\u00e4gi, C., and Persson, C. (2021). Functional Properties of Low-Modulus PMMA Bone Cements Containing Linoleic Acid. J. Funct. Biomater., 12.","DOI":"10.3390\/jfb12010005"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"104437","DOI":"10.1016\/j.jmbbm.2021.104437","article-title":"Long-term mechanical properties of a novel low-modulus bone cement for the treatment of osteoporotic vertebral compression fractures","volume":"118","author":"Robo","year":"2021","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1007\/s00586-003-0556-5","article-title":"The importance of the endplate for interbody cages in the lumbar spine","volume":"12","author":"Polikeit","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1007\/s00586-005-0915-5","article-title":"The long-term mechanical integrity of non-reinforced PEEK-OPTIMA polymer for demanding spinal applications: Experimental and finite-element analysis","volume":"15","author":"Ferguson","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1007\/s00586-002-0505-8","article-title":"Factors influencing stresses in the lumbar spine after the insertion of intervertebral cages: Finite element analysis","volume":"12","author":"Polikeit","year":"2003","journal-title":"Eur. Spine J."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.spinee.2020.07.016","article-title":"Biomechanical effects of laminectomies in the human lumbar spine: A finite element study","volume":"21","author":"Spina","year":"2021","journal-title":"Spine J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"E992","DOI":"10.1097\/01.brs.0000250177.84168.ba","article-title":"Biomechanical Rationale for Using Polyetheretherketone (PEEK) Spacers for Lumbar Interbody Fusion\u2013A Finite Element Study","volume":"31","author":"Vadapalli","year":"2006","journal-title":"Spine"},{"key":"ref_30","unstructured":"(2021, July 06). Standard\u2014Implants for Surgery\u2014Acrylic Resin Cements ISO 5833, Sven. Institutet F\u00f6r Stand. SIS. (n.d.). Available online: https:\/\/www.sis.se\/produkter\/halso-och-sjukvard\/medicinsk-utrustning\/kirurgiska-implantat-proteser-och-ortoser\/iso5833\/."},{"key":"ref_31","unstructured":"R Core Team (2014). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: http:\/\/www.R-project.org\/."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"464","DOI":"10.3758\/s13428-019-01246-w","article-title":"Robust statistical methods in R using the WRS2 package","volume":"52","author":"Mair","year":"2020","journal-title":"Behav. Res. Methods"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1080\/10255842.2018.1478967","article-title":"FEBio finite element models of the human lumbar spine","volume":"21","author":"Finley","year":"2018","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1080\/10255842.2010.493517","article-title":"Parametric convergence sensitivity and validation of a finite element model of the human lumbar spine","volume":"14","author":"Ayturk","year":"2011","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"061009","DOI":"10.1115\/1.4004287","article-title":"Finite Element Lumbar Spine Facet Contact Parameter Predictions are Affected by the Cartilage Thickness Distribution and Initial Joint Gap Size","volume":"133","author":"Woldtvedt","year":"2011","journal-title":"J. Biomech. Eng."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"S663","DOI":"10.1007\/s00586-010-1382-1","article-title":"Effect of multilevel lumbar disc arthroplasty on spine kinematics and facet joint loads in flexion and extension: A finite element analysis","volume":"21","author":"Schmidt","year":"2012","journal-title":"Eur. Spine J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2484","DOI":"10.1016\/j.jbiomech.2005.07.026","article-title":"Analysis of the influence of disc degeneration on the mechanical behaviour of a lumbar motion segment using the finite element method","volume":"39","author":"Rohlmann","year":"2006","journal-title":"J. Biomech."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1016\/j.jbiomech.2014.06.008","article-title":"Validation and application of an intervertebral disc finite element model utilizing independently constructed tissue-level constitutive formulations that are nonlinear, anisotropic, and time-dependent","volume":"47","author":"Jacobs","year":"2014","journal-title":"J. Biomech."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1007\/s005860050045","article-title":"Testing criteria for spinal implants: Recommendations for the standardization of in vitro stability testing of spinal implants","volume":"7","author":"Wilke","year":"1998","journal-title":"Eur. Spine J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1097\/00007632-199904150-00005","article-title":"New In Vivo Measurements of Pressures in the Intervertebral Disc in Daily Life","volume":"24","author":"Wilke","year":"1999","journal-title":"Spine"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"11005","DOI":"10.1115\/1.4005694","article-title":"FEBio: Finite Elements for Biomechanics","volume":"134","author":"Maas","year":"2012","journal-title":"J. Biomech. Eng."},{"key":"ref_42","unstructured":"(2021, December 18). G21 (G21 S.r.l., San Possidonio, Italy). G21\u2014Bone Cements for Vertebral Consolidation (Product Information) 2021. Available online: http:\/\/madison-medical.gr\/images\/PDF%20cements\/G-21_Bone%20cements%20for%20vertebral%20consolidation%20-%20ENG.pdf."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"104247","DOI":"10.1016\/j.jmbbm.2020.104247","article-title":"Mechanical and morphological characterization of PMMA\/bone composites in human femoral heads","volume":"115","author":"Sas","year":"2021","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1002\/jbm.b.31886","article-title":"Experimental and computational models to investigate the effect of adhesion on the mechanical properties of bone-cement composites","volume":"99","author":"Helgason","year":"2011","journal-title":"J. Biomed. Mater. Res. B Appl. Biomater."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1016\/j.jbiomech.2012.02.012","article-title":"The mechanical behavior of PMMA\/bone specimens extracted from augmented vertebrae: A numerical study of interface properties, PMMA shrinkage and trabecular bone damage","volume":"45","author":"Kinzl","year":"2012","journal-title":"J. Biomech."},{"key":"ref_46","first-page":"131","article-title":"A novel three-dimensional volumetric method to measure indirect decompression after percutaneous cement discoplasty","volume":"28","author":"Eltes","year":"2021","journal-title":"J. Orthop. Transl."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"E427","DOI":"10.1097\/BRS.0b013e3181a2ea0a","article-title":"A study on the structural properties of the lumbar endplate: Histological structure, the effect of bone density, and spinal level","volume":"34","author":"Hou","year":"2009","journal-title":"Spine"}],"container-title":["Journal of Functional Biomaterials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-4983\/13\/1\/18\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:13:59Z","timestamp":1760134439000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-4983\/13\/1\/18"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,4]]},"references-count":47,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["jfb13010018"],"URL":"https:\/\/doi.org\/10.3390\/jfb13010018","relation":{},"ISSN":["2079-4983"],"issn-type":[{"value":"2079-4983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,4]]}}}