Percutaneous Cement Discoplasty for the Treatment of Advanced Degenerative Disc Conditions: A Case Series Analysis

Abstract

Study Design: Retrospective analysis. Level of evidence III. Objectives: To describe the results after a minimum 1-year follow-up in patients treated with percutaneous discoplasty (PD), a minimally invasive technique to treat low back pain in elderly patients with advanced degenerative disc disease. The procedure consists in improving stability by injecting bone cement in a severely degenerated pneumodisc. There are few reports in the literature about this technique. Methods: Fifty-four patients with advanced disc disease with/without degenerative scoliosis treated with PD with at least 1 year follow-up were studied, variables included clinical (visual analogue scale [VAS] and Owestry Disability Index [ODI]) and radiological parameters (lumbar lordosis and Cobb angle), as well as hospital length of stay and complications. Results: At 1-year postoperation, significant pain reduction (VAS: preoperative 7.8 ± 0.90; postoperative 4.4 ± 2.18) and improvement in the ODI (preoperative 62 ± 7.12; postoperative 36.2 ± 15.47) were observed with partial correction of radiological parameters (5° mean increase in lumbar lordosis and decrease in Cobb angle). Mean surgical time was 38 minutes, and the mean length of hospital stay was 1.2 days. Conclusion: PD, currently not a very well-known technique, appears to be—at least in the short-term follow-up—an effective treatment option in selected cases with low back pain due to advanced degenerative disc disease.

A novel three-dimensional volumetric method to measure indirect decompression after percutaneous cement discoplasty

“…Percutaneous cement discoplasty (PCD) is a MIS procedure, where the vacuum space in the intervertebral disc is filled out with percutaneously injected PMMA (Polymethylmethacrylate), which provides a segmental stabilizing effect and indirect decompression of the neuronal elements due to the increase of the spinal canal dimensions. The technical details, the clinical effect and safety issues of the procedure have been previously published and the usage of the technique has also been supported by a prospective radiological study [ [9] , [10] , [11] , [12] ].…”

Development of a New Therapy-Oriented Classification of Intervertebral Vacuum Phenomenon With Evaluation of Intra- and Interobserver Reliabilities

“…On the other hand, partial VP could be an indication for percutaneous discoplasty, with some concerns regarding the increased risk of adjacent fractures in the absence of subchondral sclerosis (type 2A), the same concept should be applied to type 3A, as we believe that subchondral sclerosis plays a role in preventing vertebral fracture. However, in our case series of 54 patients treated with PD, 11 only 1 case suffered vertebral fracture after PD in a type 2A vacuum and required vertebroplasty, having just a few evidence in the literature, this concept is just theoretical and needs to be supported by biomechanical and clinical studies.…”

“…This treatment is based on the concept of polymethyl methacrylate (PMMA) injection in the disc space in advances stages of degeneration with vacuum phenomenon, acting as a stabilizer intervertebral spacer, this treatment has demonstrated low back and leg pain improvement and partial correction of spinal balance in unbalanced cases with low complication rates and short hospital stay. [9][10][11] Yamada et al 23 reported improvement in low back pain in 109 patients with degenerative lumbar scoliosis treated with percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI), although the name of the procedure differs, the concept is the same. A proper patient selection is necessary, with correct identification of the pain source and some image characteristics may contribute to decrease the risk of some complications such as adjacent vertebral fracture, cement leakage, or disc material protrusion associated with PMMA injection.…”

“…In order to evaluate inter-and intraobserver reliabilities for this new classification, a designer team (authors of this study) selected CT scan images of 25 cases (5 cases of stage I, IIA, IIB, IIIA, and IIIB), each case scenario included 3 CT images each (3 coronal tomographic images from the anterior middle and posterior third of the vertebral disc unit for the scoliotic spine and 3 sagittal tomographic images from the right parasagittal middle and left parasagittal third of the vertebral disc unit for the nonscoliotic spine). All cases derived from our database of approximately 500 surgical procedures from 2013 to 2018 of degenerative lumbar disease in our institution, including our 54 cases treated with PD [11], all cases were selected by the authors of the classification.…”

“…This technique has been shown to improve pain and disability and looks like a good treatment option, especially among elderly patients in whom traditional fusion procedures are associated with a higher risk of complications. [9][10][11] Indications for PD are low back pain or radicular pain along with the presence of VP; however, this imaging finding varies widely and not all cases of VP are considered suitable for discoplasty.…”