Kiyotaka Yamada1, Toshio Nakamae2, Kazuyoshi Nakanishi3, Naosuke Kamei2, Takeshi Hiramatsu1, Teruaki Okuda1, Takashi Hashimoto1, Satoshi Ujigo1, Taiki Morisako2, Yuji Tsuchikawa2, Toshiaki Maruyama1, Hiroki Fukui1, Nobuo Adachi2, Takuro Shimbo4, Kjell Olmarker5, Yoshinori Fujimoto6. 1. Department of Orthopaedic Surgery, Spine Center, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan. 2. Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. 3. Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan. 4. Ohta Nishinouchi Hospital, Fukushima, Japan. 5. Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Muskuloskeletal Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 6. Department of Orthopaedic Surgery, Spine Center, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan. skydog1018@m6.dion.ne.jp.
Abstract
PURPOSE: Treatment of low back pain (LBP) associated with elderly degenerative lumbar scoliosis (DLS) remains controversial. We have developed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) targeting to the intervertebral vacuum as a minimally invasive surgery. The present study compared the long-term clinical outcomes of PIPI to that of nonoperative treatment. METHODS: Patients with de novo DLS, aged ≥ 65 years, who had LBP with visual analog scale (VAS) of ≥ 50 for ≥ 6 months with intervertebral vacuum on computed tomography and bone marrow edema (BME) on magnetic resonance imaging were included. The clinical outcomes were evaluated using VAS and the Oswestry Disability Index (ODI) at baseline, 1, 6, 12, 24 months, and at the final follow-up. The course of BME was also evaluated. RESULTS: One hundred and one patients underwent PIPI and 61 received nonoperative treatment. The mean follow-up duration after PIPI and nonoperative treatment was 63.7 ± 32.4 and 43.9 ± 20.9 months, respectively. VAS and ODI after PIPI were significantly improved compared to post-nonoperative treatment. BME decreased substantially in the PIPI group and it was significantly correlated with VAS and ODI improvement. Following PIPI, LBP recurred in 28 patients (35%). LBP recurrence was identified at the same level of PIPI in 10 patients, at the adjacent level of PIPI in 11 patients, and at the non-adjacent level of PIPI in seven patients. Eighteen patients underwent additional PIPIs, and both VAS and ODI were significantly improved after additional PIPIs. CONCLUSION: Bone marrow lesions of the endplate are strongly associated with the presence of LBP. PIPI can be considered as an effective, safe and repeatable treatment for LBP in elderly DLS patients.
PURPOSE: Treatment of low back pain (LBP) associated with elderly degenerative lumbar scoliosis (DLS) remains controversial. We have developed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI) targeting to the intervertebral vacuum as a minimally invasive surgery. The present study compared the long-term clinical outcomes of PIPI to that of nonoperative treatment. METHODS: Patients with de novo DLS, aged ≥ 65 years, who had LBP with visual analog scale (VAS) of ≥ 50 for ≥ 6 months with intervertebral vacuum on computed tomography and bone marrow edema (BME) on magnetic resonance imaging were included. The clinical outcomes were evaluated using VAS and the Oswestry Disability Index (ODI) at baseline, 1, 6, 12, 24 months, and at the final follow-up. The course of BME was also evaluated. RESULTS: One hundred and one patients underwent PIPI and 61 received nonoperative treatment. The mean follow-up duration after PIPI and nonoperative treatment was 63.7 ± 32.4 and 43.9 ± 20.9 months, respectively. VAS and ODI after PIPI were significantly improved compared to post-nonoperative treatment. BME decreased substantially in the PIPI group and it was significantly correlated with VAS and ODI improvement. Following PIPI, LBP recurred in 28 patients (35%). LBP recurrence was identified at the same level of PIPI in 10 patients, at the adjacent level of PIPI in 11 patients, and at the non-adjacent level of PIPI in seven patients. Eighteen patients underwent additional PIPIs, and both VAS and ODI were significantly improved after additional PIPIs. CONCLUSION: Bone marrow lesions of the endplate are strongly associated with the presence of LBP. PIPI can be considered as an effective, safe and repeatable treatment for LBP in elderly DLS patients.
Authors: Michael P Kelly; Jon D Lurie; Elizabeth L Yanik; Christopher I Shaffrey; Christine R Baldus; Oheneba Boachie-Adjei; Jacob M Buchowski; Leah Y Carreon; Charles H Crawford; Charles Edwards; Thomas J Errico; Steven D Glassman; Munish C Gupta; Lawrence G Lenke; Stephen J Lewis; Han Jo Kim; Tyler Koski; Stefan Parent; Frank J Schwab; Justin S Smith; Lukas P Zebala; Keith H Bridwell Journal: J Bone Joint Surg Am Date: 2019-02-20 Impact factor: 5.284
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