Advanced disc degeneration, bi-planar instability and pathways of peri-discal gas suffusion contribute to pathogenesis of intradiscal vacuum phenomenon

Kanna, Rishi Mugesh; Hajare, Swapnil; Thippeswamy, Pushpa Bhari; Shetty, Ajoy Prasad; Rajasekaran, S.

doi:10.1007/s00586-022-07122-0

Cited by 10 publications

(16 citation statements)

References 19 publications

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“…Kanna et al observed a prevalence of vacuum of 47% in 721 patients, with L5-sacrum as the most frequent level involved. The authors also observed a multilevel vacuum prevalence of 12.5% (19).…”

Section: Discussionmentioning

confidence: 85%

“…Increased population age is a well-known factor for disc degeneration (20). Regarding the vacuum phenomenon, Kanna et al observed that patients with the vacuum phenomenon were older than those without the vacuum phenomenon in a series of 721 patients (19). In addition, similar to our study, the authors found no association between vacuum and sex.…”

Section: Discussionmentioning

confidence: 99%

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Intervertebral vacuum phenomenon – prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study

et al. 2022

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Background Chronic low back pain secondary to degenerative changes in the spine is a common cause of disability, and disc degeneration is one of the most frequent imaging findings. Intervertebral vacuum phenomenon (IVP) is usually observed in advanced degeneration. Recently, this phenomenon has gained interest due to a relatively new surgical technique called percutaneous discoplasty, aimed at treating low back pain secondary to degenerative disc disease in elderly patients. Purpose To analyze the prevalence and related factors of the vacuum phenomenon in adult patients. Material and Methods A retrospective cohort study was performed of patients who underwent abdominal computed tomography (CT) for non-spine-related reasons. Age, body mass index, smoking, and CT-based characteristics as presence of IVP, subchondral sclerosis, and facet joint degeneration at the lumbar spine from L1 to the sacrum were included in order to determine the prevalence of the vacuum phenomenon in this population and establish a relationship between this condition and patient demographics and other signs of spine degeneration, such as sclerosis and facet joint disease. Results A total of 238 patients were included in the study (114 men, 124 women; mean age = 75.6 ± 12.3 years. In total, 91 (38%) patients had at least one level of IVP; 59 (25%) patients exhibited subchondral sclerosis, and 235 (98%) facet joint degeneration. Among risk factors, age, smoking, and subchondral sclerosis were significantly associated with the presence of vacuum. Conclusion IVP was present in 38% of participants. Risk factors associated with vacuum were age, smoking, and subchondral sclerosis.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Intervertebral vacuum phenomenon – prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study

et al. 2022

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“…This technique has been shown to be effective not only for LBP but also for radicular pain due to degenerative foraminal stenosis (21,22). More recently, IVP has also been linked with endplate degeneration and segmental instability (23)(24)(25). Different authors using the PCD technique agree that advanced disc degeneration with IVP is potentially the main cause of LBP.…”

Section: Discussionmentioning

confidence: 99%

Association between Modic changes and intervertebral vacuum phenomenon severity in patients undergoing percutaneous cement discoplasty

Camino-Willhuber,

Kido,

Vildoza

et al. 2023

Acta Radiol

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Background Modic changes and intervertebral vacuum phenomenon (IVP) are considered spinal degenerative changes. The correlation between Modic and IVP has not been analyzed in the literature. Purpose To analyze the correlation between IVP severity, Modic changes, and subchondral sclerosis across the lumbar spine in patients with lumbar degeneration. Material and Methods This is a retrospective study analyzing patients who underwent percutaneous cement discoplasty at a single institution between 2015 and 2020. Preoperative magnetic resonance imaging and computed tomography scans were analyzed to make the measurements. Modic type and grade as well as severity of IVP were preoperatively measured. The association between Modic type, grade, subchondral sclerosis, and the presence of IVP was analyzed. Results In total, 110 patients (mean age = 77.03 ± 7.1 years) were finally included in the study. Per level correlation analysis showed a significant positive association between IVP and Modic type, IVP and Modic grade, and IVP and subchondral sclerosis. Moreover, subchondral sclerosis was significantly associated with Modic type and grade. Conclusion Our study showed a significant positive correlation among Modic changes, IVP, and subchondral sclerosis throughout the lumbar spine. Our findings support the theory that endplate degeneration parameters are associated with the presence and severity of IVP.

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“…This severity categorization of vacuum was described by Camino-Willhuber et al 23 and originally described for proper patient selection for percutaneous cement discoplasty, a minimally invasive procedure aimed to fill the vacuum with PMMA and, therefore, provide intersomatic stability in elderly patients. [12][13][14][15][16][17][18][19][20] The vacuum is classified as minimal, moderate and severe or total. In this regard, we found that patients with severe vacuum had greater preoperative back pain and worse preoperative ODI scores compared with patients with minimal to moderate vacuum.…”

Section: Discussionmentioning

confidence: 99%

“…38 On the basis of these previous studies, IVP seems to play a role in segmental instability by allowing more movement on dynamic x-rays. 12,15 Patients with spondylolisthesis and vacuum would benefit from interbody fusion as opposed to only posterolateral fusion.…”

Section: Discussionmentioning

confidence: 99%

Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis

Camino-Willhuber,

Schönnagel,

Caffard

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Retrospective study of prospective collected data. Objective: To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis. Summary of Background Data: IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed. Methods: We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis. Results: A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62–72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12–2.60), P=0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04–3.76), P=0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02–1.35), P=0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery. Conclusion: Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.

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Advanced disc degeneration, bi-planar instability and pathways of peri-discal gas suffusion contribute to pathogenesis of intradiscal vacuum phenomenon

Cited by 10 publications

References 19 publications

Intervertebral vacuum phenomenon – prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study

Intervertebral vacuum phenomenon – prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study

Association between Modic changes and intervertebral vacuum phenomenon severity in patients undergoing percutaneous cement discoplasty

Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis

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