Indirect foraminal decompression and improvement in the lumbar alignment after percutaneous cement discoplasty
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.
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.
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).
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.
KeywordsPercutaneous cement discoplasty Radiological parameters Outcome Lumbar alignment Indirect foraminal decompression
Aron Lazary has received research grants from the Hungarian Scientific Research Fund, Budapest, Hungary, Award number: OTKA FK123884.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Varga PP, Jakab G, Bors IB, Lazary A, Szoverfi Z (2015) Experiences with PMMA cement as a stand-alone intervertebral spacer: percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs. Der Orthopade 44(Suppl 1):S1–S7. https://doi.org/10.1007/s00132-014-3060-1 CrossRefGoogle Scholar
- 10.Ostelo RW, Deyo RA, Stratford P, Waddell G, Croft P, Von Korff M, Bouter LM, de Vet HC (2008) Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change. Spine 33:90–94. https://doi.org/10.1097/BRS.0b013e31815e3a10 CrossRefGoogle Scholar
- 12.Chapman TM Jr, Baldus CR, Lurie JD, Glassman SD, Schwab FJ, Shaffrey CI, Lafage V, Boachie-Adjei O, Kim HJ, Smith JS, Crawford CH 3rd, Lenke LG, Buchowski JM, Edwards C 2nd, Koski T, Parent S, Lewis S, Kang DG, McClendon J Jr, Metz L, Zebala LP, Kelly MP, Spratt KF, Bridwell KH (2016) Baseline patient-reported outcomes correlate weakly with radiographic parameters: a multicenter, prospective NIH adult symptomatic lumbar scoliosis study of 286 patients. Spine 41:1701–1708. https://doi.org/10.1097/BRS.0000000000001613 CrossRefGoogle Scholar
- 16.Malham GM, Parker RM, Goss B, Blecher CM (2015) Clinical results and limitations of indirect decompression in spinal stenosis with laterally implanted interbody cages: results from a prospective cohort study. European Spine J 24(Suppl 3):339–345. https://doi.org/10.1007/s00586-015-3807-3 CrossRefGoogle Scholar