Targeted Therapy for Low Back Pain in Elderly Degenerative Lumbar Scoliosis

Yamada, Kiyotaka; Nakamae, Toshio; Shimbo, Takuro; Kanazawa, Toshikatsu; Okuda, Teruaki; Takata, Haruhiko; Hashizume, Takumi; Hiramatsu, Takeshi; Tanaka, Nobuhiro; Olmarker, Kjell; Fujimoto, Yoshinori

doi:10.1097/brs.0000000000001524

Cited by 27 publications

(24 citation statements)

References 43 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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“…Low back pain (axial pain) is often the main symptom at onset and the chief complaint at the first visit to the clinic for DS. Recent studies have shown that paraspinal muscle spasm caused by sagittal and coronal imbalance is the main mechanism of low back pain [ 23 ]. Unfortunately, dramatic pain relief is not established in some patients, and 15–30% continue to experience chronic pain in the months and years after surgery [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Short-Segment Fixation versus Long-Segment Fixation for Degenerative Scoliosis with Cobb Angle 20°~40°: A Retrospective Observational Study

Zhu

et al. 2020

Med Sci Monit

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Background There remains a great deal of controversy regarding the selection of long-segment fixation and short-segment fixation, especially for degenerative scoliosis (DS) patients with Cobb angle 20°~40°. The purpose of this study was to investigate the effects of different fixation levels in DS patients with Cobb angle 20°~40°. Material/Methods We enrolled 96 DS patients, divided into a long-segment fixation group (>3 segments) and a short-segment fixation group (≤3 segments). The visual analogue scale (VAS) and Oswestry disability index (ODI) were used to evaluate the clinical outcomes. The spinal-pelvic parameters and complications were also collected and analyzed. Results The short-segment fixation group had the advantages of less blood loss, shorter operation time and shorter fluoroscopy time (P<0.05). The 2 groups achieved similar effects in leg pain (VAS) and ODI after operation (P>0.05); however, there was a better relief of low back pain in the long-segment fixation group (P<0.05 ) . The changes of Cobb angle, sagittal vertical axis (SVA), lumbar lordosis (LL), pelvic tilt (PT) and sacral slope (SS) in the long-segment fixation group were more obvious than that in the short-segment fixation group at the final follow-up (P<0.05). The prevalence of complications in the long-segment fixation group was significantly higher than in the short-segment fixation group (P<0.01). Conclusions Short-segment fixation has less surgical trauma and fewer complications, whereas long-segment fixation has more advantages in improving spine-pelvis parameters and relieving low back pain.

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“…2 ASD has been shown to dramatically negatively affect quality of life and surgery to correct these deformities can significantly improve both spinal alignment and health-related quality of life. [3][4][5][6][7] Correcting spinal deformity is demanding for both the surgeon and the patient; it is fraught with post-operative complications, including mechanical complications necessitating additional surgery that is time consuming, painful, and expensive. [8][9][10] Proximal junctional kyphosis (PJK), a change in proximal junctional sagittal Cobb angle of 10 and at least 10 greater than preoperative angle, is a devastating mechanical complication of ASD surgery that has been posited to be multi-factorial, influenced by biology, bone quality, neurological disorders, construct factors, and alignment.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Global Alignment and Proportion Score and Bracing on Proximal Junctional Kyphosis in Adult Spinal Deformity

Lord

Ayres

Woo

et al. 2021

Global Spine Journal

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Study Design: Retrospective chart review. Objective: The goal of this study is to examine the relationship between global alignment and proportion (GAP) score and postoperative orthoses with likelihood of developing proximal junctional kyphosis (PJK). Methods: Patients who underwent thoracic or lumbar fusions of ≥4 levels for adult spinal deformity (ASD) with 1-year post-operative alignment x-rays were included. Chart review was conducted to determine spinopelvic alignment parameters, PJK, and reoperation. Results: A total of 81 patients were included; baseline and 1-year postoperative alignment did not differ between patients with and without PJK. There was no PJK in 53.1%, 29.6% had PJK from 10-20°, and 17.3% had severe PJK over 20° (sPJK). At baseline, 80% of patients had severely disproportioned GAP, 13.75% moderate, 6.25% proportioned. GAP improved across the population, but improved GAP was not associated with sPJK. Greater correction of the upper instrumented vertebra to pelvic angle (UIV-PA) was associated with a larger PJK angle (PJKA) change (R = -0.28) as was the 1 year T1-upper instrumented vertebra (T1-UIV) angle (R = 0.30), both P < .05. GAP change was not correlated with PJKA change. Postoperative orthoses were used in 46% of patients and did not impact sPJK. Conclusions: There was no correlation between PJK and GAP or change in GAP. Greater correction of UIV-PA and larger postop T1-UIV was associated with greater PJKA change; suggesting that the greater alignment correction led to greater likelihood of failure. Postoperative orthoses had no impact on PJK.

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Targeted Therapy for Low Back Pain in Elderly Degenerative Lumbar Scoliosis

Abstract: 3.

Cited by 27 publications

References 43 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

Effectiveness of Short-Segment Fixation versus Long-Segment Fixation for Degenerative Scoliosis with Cobb Angle 20°~40°: A Retrospective Observational Study

The Impact of Global Alignment and Proportion Score and Bracing on Proximal Junctional Kyphosis in Adult Spinal Deformity

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