Indirect Foraminal Decompression and Improvement in the Lumbar Alignment After Percutaneous Cement Discoplasty

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2019 Apr 22

PMID 31006068

Citations 24

Authors

Laszlo Kiss

Peter Pal Varga

Zsolt Szoverfi

Gabor Jakab

Peter Endre Eltes

Aron Lazary

Affiliations

Soon will be listed here.

Abstract

Purpose: Percutaneous cement discoplasty (PCD) is a minimally invasive surgical procedure, that can provide a segmental stabilizing and indirect decompression effect in case of severely degenerated discs characterized by vacuum phenomenon. The objective of this study was to evaluate the effects of PCD on spinopelvic radiological parameters and their associations with the clinical outcome.

Methods: Retrospective analysis of prospectively collected dataset of 28 patients (112 lumbar segments) who underwent single- or multilevel PCD was performed. Spinopelvic, intrasegmental and intersegmental parameters were measured on lumbar X-rays pre-, postoperatively and 6 months after the surgery. Correlations between radiological parameters and clinical outcome data were determined.

Results: Sacral slope significantly increased (p < .001), and pelvic tilt (p < .05) was decreased after the PCD procedure. Segmental and total lordosis (p < .05, p < .05) disc and foraminal height showed significantly increase (p < .001, p < .001) after procedure. Pain and disability (ODI) significantly decreased due to PCD. An association was found between postoperative increase in SS and improvement in ODI (r = 0.39, p < .05). The change in low back pain was correlated with segmental scoliosis correction (p < .001). Moderate correlation was detected between the increase in disc height and ODI (p < .05) as well as leg pain (p < .01).

Conclusion: PCD is an effective minimally invasive technique to treat axial pain and disability related to severe lumbar disc degeneration. Our study shows that an improvement in lumbar alignment and a significant indirect foraminal decompression could be achieved with the procedure. These changes can significantly contribute to the pain relief and increase in the patients' functional capacity. These slides can be retrieved under Electronic Supplementary Material.

Citing Articles

Efficacy of percutaneous cement discoplasty combined with PVP for the treatment of stage III Kümmell disease with an adjacent disc vacuum sign.

Liu L, Li P, Luo L, Zhao C, Zhang H, Liu D Front Surg. 2025; 12:1538964.

PMID: 40040814 PMC: 11876409. DOI: 10.3389/fsurg.2025.1538964.

Biomechanical Behavior of Injected Cement Spacers versus Traditional Cages in Low-Density Lumbar Spine under Compression Loading.

Csakany T, Varga P, Gueorguiev B, Lakatos E, Kurutz M Medicina (Kaunas). 2024; 60(7).

PMID: 39064584 PMC: 11278875. DOI: 10.3390/medicina60071155.

Finite element analysis of biomechanical effects of percutaneous cement discoplasty in scoliosis.

Yang C, Wang F, Huang X, Zhang H, Shi S, Zhang F BMC Musculoskelet Disord. 2024; 25(1):285.

PMID: 38609902 PMC: 11015543. DOI: 10.1186/s12891-023-06741-y.

Efficacy and safety of percutaneous cement discoplasty in the management of degenerative spinal diseases: A systematic review and meta-analysis.

Grewal S, Hirsch J, Cancelliere N, Ghozy S, Pereira V, Dmytriw A Neuroradiol J. 2023; 37(4):434-440.

PMID: 37920948 PMC: 11366206. DOI: 10.1177/19714009231212368.

When spinal instrumentation revision is not an option: Salvage vertebral augmentation with polymethylmethacrylate for mechanical complications: A systematic review.

Cawley D, Divani K, Shafafy R, Devitt A, Molloy S Brain Spine. 2023; 3:101726.

PMID: 37383448 PMC: 10293288. DOI: 10.1016/j.bas.2023.101726.

References

Pfirrmann C, Metzdorf A, Zanetti M, Hodler J, Boos N . Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976). 2001; 26(17):1873-8. DOI: 10.1097/00007632-200109010-00011. View

Dindo D, Demartines N, Clavien P . Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240(2):205-13. PMC: 1360123. DOI: 10.1097/01.sla.0000133083.54934.ae. View

Leone A, Guglielmi G, Cassar-Pullicino V, Bonomo L . Lumbar intervertebral instability: a review. Radiology. 2007; 245(1):62-77. DOI: 10.1148/radiol.2451051359. View

Ostelo R, Deyo R, Stratford P, Waddell G, Croft P, Von Korff M . Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine (Phila Pa 1976). 2008; 33(1):90-4. DOI: 10.1097/BRS.0b013e31815e3a10. View

Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K . Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J. 2010; 19(3):435-8. PMC: 2899756. DOI: 10.1007/s00586-009-1240-1. View

Adams M, Dolan P . Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat. 2012; 221(6):497-506. PMC: 3512277. DOI: 10.1111/j.1469-7580.2012.01551.x. View

Dolan P, Luo J, Pollintine P, Landham P, Stefanakis M, Adams M . Intervertebral disc decompression following endplate damage: implications for disc degeneration depend on spinal level and age. Spine (Phila Pa 1976). 2013; 38(17):1473-81. DOI: 10.1097/BRS.0b013e318290f3cc. View

Castellvi A, Nienke T, Marulanda G, Murtagh R, Santoni B . Indirect decompression of lumbar stenosis with transpsoas interbody cages and percutaneous posterior instrumentation. Clin Orthop Relat Res. 2014; 472(6):1784-91. PMC: 4016450. DOI: 10.1007/s11999-014-3464-6. View

Malham G, Parker R, Goss B, Blecher C . Clinical results and limitations of indirect decompression in spinal stenosis with laterally implanted interbody cages: results from a prospective cohort study. Eur Spine J. 2015; 24 Suppl 3:339-45. DOI: 10.1007/s00586-015-3807-3. View

10.

Varga P, Jakab G, Bors I, Lazary A, Szoverfi Z . Experiences with PMMA cement as a stand-alone intervertebral spacer: Percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs. Orthopade. 2015; 44 Suppl 1:S1-7. DOI: 10.1007/s00132-014-3060-1. View

11.

Beyer F, Geier F, Bredow J, Oppermann J, Eysel P, Sobottke R . Influence of spinopelvic parameters on non-operative treatment of lumbar spinal stenosis. Technol Health Care. 2015; 23(6):871-9. DOI: 10.3233/THC-151032. View

12.

Pereira E, Farwana M, Lam K . Extreme lateral interbody fusion relieves symptoms of spinal stenosis and low-grade spondylolisthesis by indirect decompression in complex patients. J Clin Neurosci. 2016; 35:56-61. DOI: 10.1016/j.jocn.2016.09.010. View

13.

Chapman Jr T, Baldus C, Lurie J, Glassman S, Schwab F, Shaffrey C . Baseline Patient-Reported Outcomes Correlate Weakly With Radiographic Parameters: A Multicenter, Prospective NIH Adult Symptomatic Lumbar Scoliosis Study of 286 Patients. Spine (Phila Pa 1976). 2016; 41(22):1701-1708. PMC: 5119760. DOI: 10.1097/BRS.0000000000001613. View

14.

Simon J, Longis P, Passuti N . Correlation between radiographic parameters and functional scores in degenerative lumbar and thoracolumbar scoliosis. Orthop Traumatol Surg Res. 2016; 103(2):285-290. DOI: 10.1016/j.otsr.2016.10.021. View

15.

Eskilsson K, Sharma D, Johansson C, Hedlund R . The impact of spinopelvic morphology on the short-term outcome of pedicle subtraction osteotomy in 104 patients. J Neurosurg Spine. 2017; 27(1):74-80. DOI: 10.3171/2016.11.SPINE16601. View

16.

Sola C, Willhuber G, Kido G, Pereira Duarte M, Bendersky M, Mereles M . Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients. Eur Spine J. 2018; 30(8):2200-2208. DOI: 10.1007/s00586-018-5547-7. View