Impact of the quantity of intradiscal cement leak on the progression of intervertebral disc degeneration

Jamjoom, Bakur A.; Patel, Sanjay; Bommireddy, Rajendranadh; Klézl, Zdeněk

doi:10.1308/rcsann.2017.0083

Cited by 20 publications

(16 citation statements)

References 19 publications

(28 reference statements)

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“…When bone cement leaks to the other endplate, recompression of the vertebral body on the one hand may lead to spinal balance, local kyphosis, and thus chronic pain [23,24]. However, our study found no signi cant difference in AVHR and LKA among the groups, only statistically signi cant relative to preoperative.…”

Section: Discussioncontrasting

confidence: 70%

The analysis of the impact of bone cement leakage through the endplate on the prognosis of patients after PKP on intervertebral disc

Zhou

Hua

et al. 2022

Preprint

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Background:There is a high incidence in the elderly who come down with osteoporotic vertebral compression fracture (OVCF) and percutaneous kyphoplasty (PKP) is an effective solution which can relieve pain quickly. Previous studies have shown that both the volume and the distribution of bone cement filling are related to the clinical outcome after PKP surgery. However, the influence of bone cement leakage through the endplate after PKP on intervertebral disc remains to be explained. Methods:118 patients with single level OVCF operated by PKP were retrospectively reviewed from 2015 to 2020. These patients were grouped according to the degree of bone cement leakage. Group A: Bone cement leakage involving one endplate relative to the intervertebral disc. Group B: Bone cement leakage involving one endplate and the adjacent disc. Group C: Bone cement leakage involving both endplates of the intervertebral disc. The following variables were reviewed: gender, age, BMI, BMD and surgical parameters including cement volume (CV), Oswestry Disability Index (ODI), Visual analogue Scale (VAS), Anterior vertebral height ration (AVHR), Local kyphotic angle (LKA), Intervertebral space height (ISH) and the incidence of complications.Results:Compared with the preoperative for all groups, the VAS, ODI, AVHR, LKA and ISH were improved significantly after PKP. There is no significant difference among groups in AVHR and LKA (P> 0.05). Compared with preoperative levels, there was a significant reduction in fracture perivertebral pain in all groups after the surgery, but at the last follow-up, the VAS of Group C were worser than other groups (3.28±0.29 vs. 2.55±0.67vs. 1.73±0.51, P <0.05) and the ODI of Group C were also worser than other groups (44.46±6.65 vs. 35.77±6.33 vs. 29.80±5.96, P <0.05). At the last follow-up, the ISH of group C was worser than group B and group C (4.04±0.38 vs. 4.63±0.27 vs. 5.19±0.34, P <0.05). The complications including the adjacent vertebral fracture (AVF) and backache of group A was (1/39, 2.5%), that of group B was (6/33, 15.4%) and that of group C was (17/22, 42.5%). The incidence of complications in the group C was significantly higher than that in the other groups (P＜0.05). Conclusions:As the area of bone cement leaking from one endplate to another endplate of the intervertebral disc increases, there is no significant difference in the short-term effect after surgery, but the patient's long-term postoperative efficacy becomes worse. The incidence of AVF and back pain of adjacent vertebral bodies increases. It even aggravated the degeneration of the intervertebral disc and the symptoms of discogenic neuralgia appeared.

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Section: Discussioncontrasting

confidence: 70%

The analysis of the impact of bone cement leakage through the endplate on the prognosis of patients after PKP on intervertebral disc

Zhou

Hua

et al. 2022

Preprint

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“…While some studies reported that the leakage did not induce adjacent vertebral body collapse 41,42 , others obtained opposite results 43 . In the meantime, many studies revealed that bone cement may be toxic to the intervertebral disc and that it accelerates degeneration [44][45][46] . In our study, we did not observe a higher rate of adjacent segment fracture for the high-viscosity cement group, despite its higher intradiscal leakage rate.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Bone Cement Leakage on Vertebroplasty with High-Viscosity Cement Versus Decompressed Kyphoplasty: A Retrospective Study

Cheng¹,

Chou²,

Tsuei³

et al. 2021

Preprint

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Cement leakage is a concerning complication of percutaneous kyphoplasty or vertebroplasty, as it may lead to neurologic injury. High viscosity cement has been recently used in vertebroplasty to prevent cement leakage. In this study, we aimed to compare the results between vertebroplasty with high viscosity cement to a novel technique “decompressed kyphoplasty” that used a low viscosity cement. A total of 136 patients with a single level osteoporotic compression fracture were retrospectively included in our study. 70 patients received vertebroplasty with high viscosity cement while the other 66 patients received decompressed kyphoplasty with low viscosity cement. The overall cement leakage rate was not significantly different between the two groups (18.6% and 9.1%, p = 0.111). However, the risk of intradiscal leakage was lower for the decompressed kyphoplasty group (p = 0.011), especially when the pre-operative x-ray did not display a cleft sign. The change in the kyphotic angle and the risk of adjacent segment collapse were similar (p = 0.739 and 0.522 respectively). We concluded that decompressed kyphoplasty can reduce intradiscal cement leakage rate compared to high viscosity cement vertebroplasty. The technique is particularly useful for patient without cleft sign on x-ray to prevent intradiscal leakage.

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“…The amount of intradiscal cement leaked was quanti ed by a grading system proposed by two of the authors Z Klezl and S Patel classi cation (ZK and SP). [21] They proposed that grade I when cement leakage into the disc space was minimal / cloud, grade II when cement leakage lled <20% of the disc space, grade III when cement leakage lled 20-40% of the disc space and grade IV when cement leakage lled >40% of the disc space.…”

Section: X-ray and Ct Scan Evaluationmentioning

confidence: 99%

The Influence of Kyphoplasty on the Progression of Intervertebral Disc Degeneration: a Retrospective Cohort Study

Han

Tian

et al. 2022

Preprint

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Background: The effect of kyphoplasty or rather Polymethylmethacrylate (PMMA) on adjacent intervertebral discs is still controversial. The evidence from experimental study to clinical study presents bipolar conclusions. Therefore, in this study, we aimed to investigate the influence of percutaneous kyphoplasty (PKP) on adjacent intervertebral discs degeneration (IDD).Methods: The adjacent intervertebral discs of vertebral treated by PKP procedure are classified as experimental group, and the adjacent intervertebral discs of non-traumatized vertebral are included in the control group. The intervertebral disc height are compared by using the Mann-Whitney U test. Modified Pfirrmann Scores (MPS) differences were compared by using simple regression analysis after eliminating the influence of time. The relationship between the quantity of intradiscal cement leakage and the progression rate of disc degeneration was assessed by using MPS differences and Z Klezl and S Patel (ZK and SP) classification with simple regression analysis. Results. 264 intervertebral discs of 66 people were finally selected for the study. The comparison of intervertebral disc height differences results with a p-value of > 0.05. Comparing with MPS differences between 2 groups, in terms of upper disc scores difference, the degree of degeneration (MPS differences) increases by 0.394 compared with the control group, regardless of lower disc scores difference, MPS differences increases by 0.333 compared with the control group. Comparing the ZK and SP grade and the MPS differences of upper / lower intervertebral disc, each increase of the grade will increase the MPS differences by 0.123 / 0.155 compared with the previous level. Conclusion: PKP procedure can accelerate adjacent IDD but would not cause disc height changes in the early stage. The quantity of cement leaking into the disc space is positively correlated with the rate of progression of disc degeneration.

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Impact of the quantity of intradiscal cement leak on the progression of intervertebral disc degeneration

Cited by 20 publications

References 19 publications

The analysis of the impact of bone cement leakage through the endplate on the prognosis of patients after PKP on intervertebral disc

The analysis of the impact of bone cement leakage through the endplate on the prognosis of patients after PKP on intervertebral disc

Comparison of the Bone Cement Leakage on Vertebroplasty with High-Viscosity Cement Versus Decompressed Kyphoplasty: A Retrospective Study

The Influence of Kyphoplasty on the Progression of Intervertebral Disc Degeneration: a Retrospective Cohort Study

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