Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis

Yamada, Kiyotaka; Nakamae, Toshio; Nakanishi, Kazuyoshi; Kamei, Naosuke; Hiramatsu, Takeshi; Okuda, Teruaki; Hashizume, Takumi; Ujigo, Satoshi; Morisako, Taiki; Tsuchikawa, Yuji; Maruyama, Toshiaki; Fukui, Hiroki; Adachi, Nobuo; Shimbo, Takuro; Olmarker, Kjell; Fujimoto, Yoshinori

doi:10.1007/s00586-021-06805-4

Cited by 23 publications

(26 citation statements)

References 53 publications

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“…The articles found included four prospective studies ( 9 , 16 – 18 ), one case study ( 19 ), two diagnostic studies ( 20 , 21 ), five retrospective studies ( 22 – 26 ), four biomechanical studies whose only three published ( 27 – 29 ). The four remaining publications were correspondence to the Editor articulated around two distinct conversations.…”

Section: Resultsmentioning

confidence: 99%

Critical Review of the State-of-the-Art on Lumbar Percutaneous Cement Discoplasty

et al. 2022

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Interbody fusion is the gold standard surgery to treat lumbar disc degeneration disease but can be a high-risk procedure in elderly and polymorbid patients. Percutaneous Cement Discoplasty (PCD) is a minimally invasive technique developed to treat advanced stage of disc degeneration exhibiting a vacuum phenomenon. A patient-specific stand-alone spacer is created by filling the disc with polymethylmethacrylate cement, allowing to recover the disc height and improve the patient’s conditions. As it has recently been introduced in the lumbar spine, this review aims to present a transversal state-of-the-art of the surgery from its clinical practice and outcome to biomechanical and engineering topics. The literature was searched across multiple databases using predefined keywords over no limited period of time. Papers about vertebroplasty were excluded. Among 466 identified papers, the relevant ones included twelve clinical papers reporting the variations of the surgical technique, follow-up and complications, four papers reporting biomechanical ex vivo and numerical tests, and four letters related to published clinical papers. Papers presenting the operative practice are reported, as well as follow-ups up to four years. The papers found, consistently reported that PCD significantly improved the clinical status of the patients and maintained it after two years. Spine alignment was impacted by PCD: the sacral slope was significantly reduced, and disc height increased. The foramen opening correlated to the volume of injected cement. Substitutes to the acrylic cement exhibited better osteointegration and mechanical properties closer to bone tissue. Finally, limitations and risks of the surgery are discussed as well as potential improvements such as the development of new filling materials with better mechanical properties and biological integration or the investigation of the inner disc.

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Section: Resultsmentioning

confidence: 99%

Critical Review of the State-of-the-Art on Lumbar Percutaneous Cement Discoplasty

et al. 2022

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“…To the authors knowledge, no previous computational studies exist on discoplasty. Discoplasty is a relatively new clinical procedure that was developed in the clinics [ 4 , 5 , 6 , 9 ]. In addition, only one experimental biomechanics study exists as previously mentioned [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…In discoplasty, polymethylmethacrylate (PMMA) is injected into the degenerated disc. Clinical studies have shown that discoplasty significantly reduces lower back and leg pain, but also reduces spinal malalignment [ 4 , 6 , 7 , 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Low-Modulus PMMA Has the Potential to Reduce Stresses on Endplates after Cement Discoplasty

Lewin

Försth

Persson

2022

JFB

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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®, 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 °C 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.

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“…Percutaneous cement discoplasty (PCD) has emerged as a minimally invasive surgical option to treat mechanical low back pain in elderly patients with advanced lumbar degeneration and intervertebral vacuum phenomenon (1)(2)(3)(4) . This procedure consists of Polymethylmethacrylate (PMMA) injection through a cannulated needle into a partial or total intervertebral vacuum acting as a spacer and stabilizing the vertebral disc unit.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of intraoperative neuromonitoring during percutaneous cement discoplasty

Camino-Willhuber

Bendersky

Vilte

et al. 2021

Rev Fac Cien Med Univ Nac Cordoba

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Introduction: Percutaneous cement discoplasty is a minimally invasive procedure to treat low back pain due to advanced degenerative disc disease in elderly patients. Complications of this procedure has been described such as infection, vertebral fracture, cement leakage and nerve injury. Intraoperative neuromonitoring is used to detect the latter. The objective of this study was to assess the usefulness of neuromonitoring during discoplasty to detect new neurological compromise. Methods: 100 consecutive patients were included in this retrospective study, (30 males and 70 females, mean age of 76.3 ± 5.71 years) with mechanical low back pain who underwent percutaneous cement discoplasty. Results: Sensitivity to detect neurological injury was 82% (CI 95% 66-98), specificity was of 99% (CI 95%98-100) with a positive predictive value of 0.95 (CI 95% 85-100) and a negative predictive value of 0.97 (CI 95% 95-99). In 5 patients neurological compromise was not detected by neuromonitoring. Discussion: Our study showed high sensitivity and specificity of neuromonitoring to detect neurological irritation during percutaneous discoplasty. Intraoperative neuromonitoring resulted an effective assistance during this minimally invasive procedure.

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Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis

Cited by 23 publications

References 53 publications

Critical Review of the State-of-the-Art on Lumbar Percutaneous Cement Discoplasty

Critical Review of the State-of-the-Art on Lumbar Percutaneous Cement Discoplasty

Low-Modulus PMMA Has the Potential to Reduce Stresses on Endplates after Cement Discoplasty

Accuracy of intraoperative neuromonitoring during percutaneous cement discoplasty

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