Mid-term efficacy of percutaneous cement discoplasty(PCD) in the treatment of axial lumbar instability

English Keywords:Bone cement  Intervertebral disc  Vacuum sign  Intervertebral instability  Percutaneous cement discoplasty

English Abstract:

  【Abstract】 Objectives: To investigate the mid-term outcomes of percutaneous cement discoplasty(PCD) in the treatment of lumbar axial instability, and analyze its technical keypoints and indications. Methods: A retrospective analysis was conducted on 9 patients with axial lumbar instability treated with PCD from January 2018 to December 2019. There were 5 males and 4 females, aged 62-87 years(75.7±8.2 years), with a follow-up period of 0.5-3 years, averaged 2.3±1.0 years. Three cases had three-disc operation at the same time, three had double-space operation and three had single-space operation, involving L2/3 disc in 3 cases, L3/4 disc in 3 cases, L4/5 disc in 4 cases, and L5/S1 disc in 3 cases. Lumbar anteroposterior and lateral radiographs in supine and standing positions were performed before operation, at postoperative 1d, 3, 6, 12 months and final follow-up to measure the height of intervertebral space of responsible level, as well as the sagittal area of intervertebral foramen at responsible level. Visual analogue scale(VAS) and Oswestry disability index(ODI) were used to evaluate the pain and function before surgery, at 1d, 3 months, 6 months, 12 months and final follow-up after operation to assess the clinical efficacy. The amount of bone cement injected in each intervertebral disc, the time of operation and the amount of blood loss were recorded respectively. Results: All the patients successfully completed the operation, no bone cement leakage occurred. The VAS score and ODI after operation were significantly improved compared with those before operation(P<0.05). The injection volume of bone cement per intervertebral disc was 3.50±0.73mL. The operative time of each disc was 16.33±1.28min, and the blood loss of each disc was 3.83±0.71mL. The height of intervertebral space of responsible level at various time points after operation was different from that before operation(P<0.05), and there was no difference in any two time points after operation. The sagittal area of intervertebral foramen at each time point after operation was different from that before operation(P<0.05), and there was difference between postoperative 1d and the final follow-up values(P<0.05). Conclusions: PCD can increase the height of the intervertebral space after surgery, relieve lumbar pain, and have a lasting effect in the treatment of lumbar instability, which is safe with satisfactory mid-term effect, and not prone to bone cement leakage, but long-term large-sample follow-up is still needed.