Cement distribution in vertebroplasties: imaging and simulation

Prophylactic vertebroplasty, the percutaneous injection of bone cement into a weak vertebral body (VB), has been shown to reinforce the bone and possibly to minimize fracture risks. Cement leakage is still a common occurrence that can cause severe complications, and smaller volumes of cement can reduce leakage occurrence. But a significant mechanical benefit is only obtained when the cement filling connects both endplates, which inevitably induces higher risks of leakage. A better understanding of the cement flow into bony structure is required to develop vertebroplasty procedures with minimized leakage risks. The aim of this project is the development of in-silico models and validation with experimental data from time-lapsed CT. The injection process will be simulated as a flow through a porous material, within the framework of the Theory of Porous Media (TPM). The tensors of permeability of the bone structure will be extracted from high resolution CT data. Incremental cement injection under time-lapsed CT will be used to monitor precisely the distribution of cement within the bone structure at different increment steps and generate experimental data to support the model findings. The result will be a significant step forward to the development of a tool that predicts the cement distribution upon injection in bone and will have a strong clinical potential.