Bone cement distribution may significantly affect the efficacy of percutaneous vertebroplasty in treating symptomatic Schmorl’s nodes

Abstract

Purpose Percutaneous vertebroplasty(PVP) has been widely used in treating symptomatic Schmorl’s nodes(SNs). However, there were still some patients with poor pain relief. At present, there is a lack of research to analyze the reasons for poor efficacy. Methods Review the SNs patients treated with PVP in our hospital from November 2019 to June 2022, collect their baseline data. Reverse reconstruction software was used to calculate the filling rate of bone edema ring(Rf). NRS score was used to evaluate pain and ODI to evaluate function. The patients were divided into remission group(RG) and non remission group(n-RG) according to symptom. In addition, according to the Rf, they were divided into excellent, good and poor groups. Differences between groups were investigated. Results A total of 26 vertebrae were included in 24 patients. When grouped according to symptoms, patients in n-RG were older, and surgical segments were tend to locate in lower lumbar spine. The proportion of Poor distribution was significantly higher. When grouped according to the cement distribution, the preoperative NRS and ODI of the three groups were comparable, but the NRS and ODI of Poor group were significantly worse than the Excellent and Good groups postoperatively and at the last follow-up. Conclusions The cement distribution may significantly affect the efficacy of PVP in treating symptomatic SNs. We suggest that the bone edema ring should be filled as fully as possible to ensure the efficacy. In addition, advanced age and low lumbar lesions are also adverse factors for clinical outcomes.

Percutaneous Vertebroplasty in a Patient with Chronic Back Pain Caused by Multiple Schmorl’s Nodes: A Case Report

“…The efficacy of PVP treatment lies in artificially accelerating local sclerosis. Inadequate cement distribution may prevent sclerotic bone from surrounding the SN and has been reported to have a negative impact on clinical outcomes such as persistent pain [17]. However, in this case, cement was injected until it reached the upper endplate where the SN is located, and the front and rear cortical edges (cement injection volume: T11, 6 mL; T12, 6 mL; L1, 6.5 mL) (Figure 4).…”

Cement-augmented pedicle screw for thoracolumbar degenerative diseases with osteoporosis: a systematic review and meta-analysis

“…At present, many scholars use a variety of ways and technology efforts to improve the stability of spinal fixation, such as some scholars in the original fixed, on the basis of supplementary anterior fixation, laminar hook and install transverse connector, and more scholars to enhance pedicle screw, pull force, reduce pine, nail and other related complications risk, constantly improve technology [ 29 ]. Bone cement has the advantages of short setting time and high curing stability, and is widely used in the treatment of osteoporosis related diseases [ 30 ]. The study of ERDEM et al [ 31 ] found that the pull-out force of pedicle screws increased significantly when using bone cement strengthening fixation, with an increase of 96–262%, while the lateral bending stiffness of pedicle screws increased by 153%, so this technique was gradually applied by spinologists to the surgical treatment of patients with degenerative diseases of the thoracolumbar spine [ 31 ].…”