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Introduction: Although rare, sternal pseudarthrosis is encountered after cardiac surgery and impacts the quality of life by triggering motion-dependent chest pain. We thought to describe its treatment by percutaneous cementoplasty and report the clinical follow-up of patients treated in our institution., Methods: This case series is a retrospective study based on five patients who benefited from a sternal cementoplasty as a treatment for symptomatic pseudarthrosis after cardiac surgery. The progression of the symptoms was assessed during clinical follow-up using the Quebec back pain disability (QBPD) scale and Visual Analog Scale (VAS)., Results: None of the patients presented evidence of local complications or neurological disorders. The intra- et post-operative images show no major leak of the cement, no embolism and no damage to the internal mammary artery or the heart. All patients described an improved quality of life due to reduced pain in all-day clinical activities. The QBPD scores improved from 54.8 ± 29.3 to 30.0 ± 17.4 ( p = 0.02) and the VAS from 7.0 ± 2.8 to 1.6 ± 1.6 ( p = 0.01). Furthermore, three out of five patients could completely stop taking analgesics., Conclusion: Sternal pseudarthrosis is a debilitating affliction that may complicate sternotomy after cardiac surgery. This series demonstrates that a more conservative approach such as cementoplasty can be successful in terms of reducing pain, and constitutes a promising technique in selected cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pittet, Cook, Khatchatourov and Theumann.)

Objective: The aim of this study was to compare the ability of 1) CT-derived bone lesion quality (classification of vertebral bone metastases [BM]) and 2) computed CT-measured volumetric bone mineral density (vBMD) for evaluating the strength and stiffness of cadaver vertebrae from donors with metastatic spinal disease., Methods: Forty-five thoracic and lumbar vertebrae were obtained from cadaver spines of 11 donors with breast, esophageal, kidney, lung, or prostate cancer. Each vertebra was imaged using microCT (21.4 μm), vBMD, and bone volume to total volume were computed, and compressive strength and stiffness experimentally measured. The microCT images were reconstructed at 1-mm voxel size to simulate axial and sagittal clinical CT images. Five expert clinicians blindly classified the images according to bone lesion quality (osteolytic, osteoblastic, mixed, or healthy). Fleiss' kappa test was used to test agreement among 5 clinical raters for classifying bone lesion quality. Kruskal-Wallis ANOVA was used to test the difference in vertebral strength and stiffness based on bone lesion quality. Multivariable regression analysis was used to test the independent contribution of bone lesion quality, computed vBMD, age, gender, and race for predicting vertebral strength and stiffness., Results: A low interrater agreement was found for bone lesion quality (κ = 0.19). Although the osteoblastic vertebrae showed significantly higher strength than osteolytic vertebrae (p = 0.0148), the multivariable analysis showed that bone lesion quality explained 19% of the variability in vertebral strength and 13% in vertebral stiffness. The computed vBMD explained 75% of vertebral strength (p < 0.0001) and 48% of stiffness (p < 0.0001) variability. The type of BM affected vBMD-based estimates of vertebral strength, explaining 75% of strength variability in osteoblastic vertebrae (R2 = 0.75, p < 0.0001) but only 41% in vertebrae with mixed bone metastasis (R2 = 0.41, p = 0.0168), and 39% in osteolytic vertebrae (R2 = 0.39, p = 0.0381). For vertebral stiffness, vBMD was only associated with that of osteoblastic vertebrae (R2 = 0.44, p = 0.0024). Age and race inconsistently affected the model's strength and stiffness predictions., Conclusions: Pathologic vertebral fracture occurs when the metastatic lesion degrades vertebral strength, rendering it unable to carry daily loads. This study demonstrated the limitation of qualitative clinical classification of bone lesion quality for predicting pathologic vertebral strength and stiffness. Computed CT-derived vBMD more reliably estimated vertebral strength and stiffness. Replacing the qualitative clinical classification with computed vBMD estimates may improve the prediction of vertebral fracture risk.