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Nakamae T, Kamei N, Yamada K, Fujimoto Y, Maruyama T, Nakao K, Farid F, Fukui H, Adachi N. Short-segment spinal fusion for chronic low back pain with bone marrow edema adjacent to the vertebral endplate in adult spinal deformity. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1061-1068. [PMID: 38072862 DOI: 10.1007/s00586-023-08028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 03/19/2024]
Abstract
PURPOSE Corrective long spinal fusion is a widely accepted surgical method for patients with adult spinal deformities. However, instrumented long fusion is associated with a significant risk of complications. Therefore, we aimed to assess the success of short-segment spinal fusion, particularly for bone marrow edema (BME) adjacent to the vertebral endplate, in patients with low back pain (LBP) and spinal deformity. METHODS A prospective study was performed at multiple hospitals wherein we monitored patients with spinal deformities and accompanying LBP. Patients aged ≥ 50 years with a minimum LBP severity score of 40 mm on the visual analog scale (VAS) were included in the study. We also included patients with lumbar BME on magnetic resonance imaging. Short spinal fusion was performed on segments with BME. Clinical evaluations of LBP on VAS and Oswestry Disability Index (ODI), and radiological parameters for sagittal vertical axis (SVA), pelvic incidence (PI), lumbar lordosis (LL) and pelvic tilt (PT) were carried out. RESULTS Overall, 35 patients (22 men and 13 women), with a mean age of 66.7 years and a mean follow-up period of 32 months, were included in the study. The mean VAS and ODI scores were 72.4 mm and 49.0% before surgery and 25.5 mm and 29.9% at the final follow-up, respectively; these parameters significantly improved after surgery. The SVA, PI-LL, and PT scores were 70.1 mm, 20.9°, and 22.8° before surgery and 85.4 mm, 13.8°, and 22.7° at the final follow-up, respectively. The spinal alignment parameters did not change significantly after surgery. CONCLUSIONS Short-segment spinal fusion is effective for treating LBP and spinal deformity with BME adjacent to the vertebral endplate without spinal correction.
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Affiliation(s)
- Toshio Nakamae
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Naosuke Kamei
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kiyotaka Yamada
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Yoshinori Fujimoto
- Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan
| | - Toshiaki Maruyama
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuto Nakao
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Fadlyansyah Farid
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
- Departement of Orthopaedic and Traumatology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - Hiroki Fukui
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Nobuo Adachi
- Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Camino-Willhuber G, Vildoza S, Martinez E, Canestrari L, Holc F, Oh M, Bhatia N, Lee YP, Bianchi H, Bendersky M. Intervertebral vacuum phenomenon - prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study. Acta Radiol 2024; 65:56-61. [PMID: 36571150 DOI: 10.1177/02841851221146666] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic low back pain secondary to degenerative changes in the spine is a common cause of disability, and disc degeneration is one of the most frequent imaging findings. Intervertebral vacuum phenomenon (IVP) is usually observed in advanced degeneration. Recently, this phenomenon has gained interest due to a relatively new surgical technique called percutaneous discoplasty, aimed at treating low back pain secondary to degenerative disc disease in elderly patients. PURPOSE To analyze the prevalence and related factors of the vacuum phenomenon in adult patients. MATERIAL AND METHODS A retrospective cohort study was performed of patients who underwent abdominal computed tomography (CT) for non-spine-related reasons. Age, body mass index, smoking, and CT-based characteristics as presence of IVP, subchondral sclerosis, and facet joint degeneration at the lumbar spine from L1 to the sacrum were included in order to determine the prevalence of the vacuum phenomenon in this population and establish a relationship between this condition and patient demographics and other signs of spine degeneration, such as sclerosis and facet joint disease. RESULTS A total of 238 patients were included in the study (114 men, 124 women; mean age = 75.6 ± 12.3 years. In total, 91 (38%) patients had at least one level of IVP; 59 (25%) patients exhibited subchondral sclerosis, and 235 (98%) facet joint degeneration. Among risk factors, age, smoking, and subchondral sclerosis were significantly associated with the presence of vacuum. CONCLUSION IVP was present in 38% of participants. Risk factors associated with vacuum were age, smoking, and subchondral sclerosis.
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Affiliation(s)
- Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Vildoza
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Martinez
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Lucia Canestrari
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Fernando Holc
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Michael Oh
- Department of Neurosurgery, University of California, Irvine, Orange, CA, USA
| | - Nitin Bhatia
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Yu-Po Lee
- Department of Orthopaedics, University of California at Irvine, Orange, CA, USA
| | - Homero Bianchi
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Intraoperative Monitoring, Pediatric Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Camino-Willhuber G, Kido G, Vildoza S, Martinez E, Tani S, Petracchi M, Gruenberg M, Sola C, Bendersky M. Association between Modic changes and intervertebral vacuum phenomenon severity in patients undergoing percutaneous cement discoplasty. Acta Radiol 2023; 64:2915-2921. [PMID: 37545178 DOI: 10.1177/02841851231191459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND Modic changes and intervertebral vacuum phenomenon (IVP) are considered spinal degenerative changes. The correlation between Modic and IVP has not been analyzed in the literature. PURPOSE To analyze the correlation between IVP severity, Modic changes, and subchondral sclerosis across the lumbar spine in patients with lumbar degeneration. MATERIAL AND METHODS This is a retrospective study analyzing patients who underwent percutaneous cement discoplasty at a single institution between 2015 and 2020. Preoperative magnetic resonance imaging and computed tomography scans were analyzed to make the measurements. Modic type and grade as well as severity of IVP were preoperatively measured. The association between Modic type, grade, subchondral sclerosis, and the presence of IVP was analyzed. RESULTS In total, 110 patients (mean age = 77.03 ± 7.1 years) were finally included in the study. Per level correlation analysis showed a significant positive association between IVP and Modic type, IVP and Modic grade, and IVP and subchondral sclerosis. Moreover, subchondral sclerosis was significantly associated with Modic type and grade. CONCLUSION Our study showed a significant positive correlation among Modic changes, IVP, and subchondral sclerosis throughout the lumbar spine. Our findings support the theory that endplate degeneration parameters are associated with the presence and severity of IVP.
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Affiliation(s)
- Gaston Camino-Willhuber
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gonzalo Kido
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Santiago Vildoza
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ezequiel Martinez
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Soji Tani
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | - Matias Petracchi
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo Gruenberg
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Carlos Sola
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi," Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
- Intraoperative Monitoring, Pediatric Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Fusini F, Girardo M, Aprato A, Massè A, Risitano S, Colò G. In Reply to the Letter to the Editor Regarding "Percutaneous Cement Discoplasty in Degenerative Spinal Disease: Systematic Review of Indications, Clinical Outcomes, and Complications". World Neurosurg 2023; 178:279. [PMID: 37803670 DOI: 10.1016/j.wneu.2023.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Federico Fusini
- Department of Orthopaedic and Traumatology, Regina Montis Regalis Hospital, Mondovì, Cuneo, Italy.
| | - Massimo Girardo
- Spine Surgery Unit, Orthopaedic and Trauma Centre, Orthopaedic and Trauma Centre, University of Turin, Turin, Italy
| | - Alessandro Aprato
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, Turin, Italy
| | - Alessandro Massè
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, Turin, Italy
| | - Salvatore Risitano
- Department of Orthopaedic and Traumatology, Orthopaedic and Trauma Centre, University of Turin, Turin, Italy
| | - Gabriele Colò
- Department of Orthopaedics and Traumatology, Regional Center for Joint Arthroplasty, ASO Alessandria, Alessandria, Italy
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Pereira Duarte M, Camino-Willhuber G, Bendersky M. Letter to the Editor Regarding "Percutaneous Cement Discoplasty in Degenerative Spinal Disease: Systematic Review of Indications, Clinical Outcomes, and Complications". World Neurosurg 2023; 178:278. [PMID: 37803669 DOI: 10.1016/j.wneu.2023.07.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 10/08/2023]
Affiliation(s)
- Matias Pereira Duarte
- Orthopaedic and Traumatology Department, Institute of Orthopedics "Carlos E. Ottolenghi", Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gaston Camino-Willhuber
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
| | - Mariana Bendersky
- III Normal Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Intraoperative Monitoring, Pediatric Neurology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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