Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients

Solá, Carlos; Camino-Willhuber, Gastón; Kido, Gonzalo; Duarte, Matias Pereira; Bendersky, Mariana; Mereles, Maximiliano; Petracchi, Matias; Gruenberg, Marcelo

doi:10.1007/s00586-018-5547-7

Cited by 39 publications

(58 citation statements)

References 18 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Camino-Willhuber

Bendersky

Cicco

et al. 2020

Global Spine Journal

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Study Design: Diagnostic study, level of evidence III. Objectives: Low back pain is a common cause of disability among elderly patients. Percutaneous discoplasty has been developed as a tool to treat degenerative disease when conservative management is not successful. Indications for this procedure include low back pain and the presence of vacuum phenomenon. The objective of this study was to describe a new classification of vacuum phenomenon based on computed tomography scan in order to improve the indications for percutaneous discoplasty. Methods: We developed a classification of vacuum phenomenon based on computed tomography scan images. We describe 3 types of vacuum based on the relationship between vacuum and the superior/inferior endplates and 2 subtypes based on the presence of significant subchondral sclerosis. A validation study was conducted selecting 10 orthopedic residents with spine surgery training to analyze 25 vacuum scenarios. Inter- and intraobserver reliabilities were assessed through the Fleiss’s and Cohen’s kappa statistics, respectively. Results: The overall Fleiss’s κ value for interobserver reliability was 0.85 (95% CI 0.82-0.86) in the first reading and 0.93 (95% CI 0.92-0.95) in the second reading. Cohen’s κ for intraobserver reliability was 0.88 (95% CI 0.77-0.99). Conclusion: The new classification has shown almost perfect inter- and intraobserver reliabilities for grading the vacuum phenomenon and could be an important tool to improve the indications for percutaneous cement discoplasty.

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Section: Discussionmentioning

confidence: 99%

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

Camino-Willhuber

Bendersky

Cicco

et al. 2020

Global Spine Journal

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“…34 In recent years, the discoplasty technique has been reported. Varga et al 43 and Carlos Sola et al 44 published their experiences with UC-PMMA as a stand-alone intervertebral spacer (percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs). They proved the feasibility of percutaneous discoplasty again.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive injectable lumbar interbody fusion with mineralized collagen-modified PMMA bone cement: A new animal model

Kong¹,

Ma²,

Wu³

et al. 2020

Journal of Applied Biomaterials & Functional Materials

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This study was to develop a feasible and safe animal model for minimally invasive injectable lumbar interbody fusion using a novel biomaterial, mineralized collagen-polymethylmethacrylate bone cement (MC-PMMA), with unilateral pedicle screw fixation in an in vivo goat model. Eight goats ( Capra aegagrus hircus) were divided into three groups: MC-PMMA, unmodified commercial-polymethylmethacrylate bone cement (UC-PMMA), and a control group (titanium cage filled with autogenous bone, TC-AB). Each group of goats was treated with minimally invasive lumbar interbody fusion at the L3/L4 and L5/L6 disc spaces (injected for MC-PMMA and UC-PMMA, implanted for TC-AB). The pedicle screws were inserted at the L3, L4, L5, and L6 vertebrae, respectively, and fixed on the left side. The characteristics of osteogenesis and bone growth were assessed at the third and the sixth month, respectively. The methods of evaluation included the survival of each animal, X-ray imaging, and 256-layer spiral computed tomography (256-CT) scanning, imaged with three-dimensional microfocus computed tomography (micro-CT), and histological analysis. The results showed that PMMA bone cement can be extruded smoothly after doping MC, the MC-PMMA integrates better with bone than the UC-PMMA, and all goats recovered after surgery without nerve damage. After 3 and 6 months, the implants were stable. New trabecular bone was observed in the TC-AB group. In the UC-PMMA group a thick fibrous capsule had formed around the implants. The MC-PMMA was observed to have perfect osteogenesis and bone ingrowth to adjacent bone surface. Minimally invasive injectable lumbar interbody fusion using MC-PMMA bone cement was shown to have profound clinical value, and the MC-PMMA showed potential application prospects.

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“…For a detailed description of the procedure see the technical note previously described by the authors. 14 …”

Section: Methodsmentioning

confidence: 99%

“…Discoplasties were performed under general intravenous anesthesia, with patients positioned in a frame with 2 rolls plus an inflatable roll under the thigh region, this roll was insufflated or deflated in order to increase or decrease lumbar lordosis and disc space height. Under fluoroscopic vision and neurophysiological monitoring, according to the technique previously described by Varga et al 12 with modifications by the authors, 14 a Jamshidi cannulated needle was placed at each compromised intervertebral disc. Polymethylmethacrylate (PMMA) (Kyphon HV-R Bone Cement) was slowly injected through the cannula with special attention to detect any sign of cement leakage into the canal or the foraminal space.…”

Section: Methodsmentioning

confidence: 99%

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

Camino-Willhuber

Kido

Duarte

et al. 2019

Global Spine Journal

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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.

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Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients

Abstract: Percutaneous discoplasty can result as an alternative minimal invasive strategy for the treatment of advanced degenerative disk disease.

Cited by 39 publications

References 18 publications

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

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

Minimally invasive injectable lumbar interbody fusion with mineralized collagen-modified PMMA bone cement: A new animal model

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

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