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Experiences with PMMA cement as a stand-alone intervertebral spacer

Percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs. English Version

Erfahrungen mit PMMA-Zement als intervertebraler Stand-alone-Platzhalter

Perkutane Zement-Diskoplastie bei Vakuumphänomen der lumbalen Bandscheiben

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Abstract

Background

The treatment of symptomatic degenerative disc disease of the lumbar spine in elderly patients by standard surgical methods is often limited due to severe comorbidities (e.g., cardiopulmonary disease, hypertonia, diabetes). Minimally invasive procedures are more acceptable in this population, since they reduce surgical morbidity and the risk of complications. The percutaneous cement discoplasty (PCD) technique was introduced by the authors to treat dynamic (and angular) instability of the symptomatic lumbar segment by injecting bone cement (polymethylmethacrylate, PMMA) into the disc spaces showing vacuum phenomena via a posterolaterally positioned Jamshidi needle. The aim of this article is to describe the indication, method, and clinical results of PCD.

Method

A total of 81 patients were treated with PCD in a tertiary care referral center over a 6-year period. The current study includes the first group of 47 consecutive patients to complete a pre- and postoperative questionnaire booklet regarding leg and back pain using the visual analog scale (VAS) and the Oswestry disability index (ODI) questionnaire.

Results

A total of 130 discs in these 47 patients were treated with PCD. The majority of patients reported a reduction in their lower back and leg pain (69 % and 66 %, respectively; p < 0.02) postoperatively. At 6-month follow-up, 61 % of patients had a minimum 10-point reduction in their ODI scores (p < 0.01).

Conclusion

Elderly patients with symptomatic dynamic foraminal stenosis and vacuum phenomenon in the intervertebral disc are suitable candidates for PCD, particularly if they represent high-risk patients for open surgery.

Zusammenfassung

Hintergrund

Die operative Behandlung einer symptomatischen degenerativen lumbalen Bandscheibenerkrankung bei älteren Patienten ist limitiert, da häufig schwere Komorbiditäten bestehen (z. B. kardiopulmonale Erkrankungen, Hypertonie, Diabetes). In dieser Population sind minimal-invasive Verfahren besser geeignet, da hierdurch die operative Morbidität und das Komplikationsrisiko gesenkt werden. Die Technik der perkutanen Zement-Diskoplastie („percutaneous cement discoplasty“, PCD) wurde von den Autoren eingeführt, um dynamische (und anguläre) Instabilitäten des symptomatischen Lendenwirbelsegments zu behandeln, indem Knochenzement (PMMA) mittels einer posterolateral positionierten Jamshidi-Nadel in die Bandscheibenzwischenräume, welche ein Vakuumphänomen aufweisen, injiziert wird. Ziel dieses Beitrags ist es, Indikation, Methode und klinische Ergebnisse der PCD zu beschreiben.

Methoden

Während eines 6-Jahres-Zeitraums wurden 81 Patienten in einem tertiären Behandlungszentrum mittels PCD behandelt. In der aktuellen Studie wurde die erste Gruppe mit 47 konsekutiven Patienten eingeschlossen, die unter Verwendung der visuellen Analogskala (VAS) und des Oswestry-Disability-Index (ODI) einen prä- und postoperativen Fragebogen bezüglich Bein- und Rückenschmerzen ausgefüllt hatten.

Ergebnisse

Bei diesen 47 Patienten wurden insgesamt 130 Bandscheiben mittels PCD behandelt. Die Mehrzahl der Patienten (69 % und 66 %) berichtete postoperativ über eine Reduzierung ihrer Schmerzen im unteren Rückenbereich und in den Beinen (p < 0,02). Beim 6-Monats-Follow-up wiesen 61 % der Patienten eine Reduzierung des ODI-Scores von mindestens 10 Punkten auf (p < 0,01).

Schlussfolgerung

Ältere Patienten mit symptomatischer dynamischer Foramenstenose und Vakuumphänomen der Bandscheiben sind geeignete Kandidaten für eine PCD, insbesondere wenn bei einem offenen Eingriff für diese Patienten ein hohes Risiko besteht.

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Authors and Affiliations

  1. National Center for Spinal Disorders, Kiralyhago u. 1–3, 1126, Budapest, Hungary

    P.P. Varga, G. Jakab, I.B. Bors, A. Lazary & Z. Szövérfi

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  1. P.P. Varga
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  2. G. Jakab
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  3. I.B. Bors
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  4. A. Lazary
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  5. Z. Szövérfi
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Correspondence to P.P. Varga.

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Conflict of interest

P.P. Varga, G. Jakab, I.B. Bors, A. Lazary, and Z. Szövérfi state that there are no conflicts of interest. All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies,

Additional information

The German translation of this article can be found under dx.doi.org/10.1007/s00132-015-3092-1

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Varga, P., Jakab, G., Bors, I. et al. Experiences with PMMA cement as a stand-alone intervertebral spacer. Orthopäde 44 (Suppl 1), 1–8 (2015). https://doi.org/10.1007/s00132-014-3060-1

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