Intervertebral vacuum phenomenon - prevalence and severity CT-scan analysis in patients older than 50 years: a retrospective cohort study

Severe Intervertebral Vacuum Phenomenon is Associated With Higher Preoperative Low Back Pain, ODI, and Indication for Fusion in Patients With Degenerative Lumbar Spondylolisthesis

STUDY DESIGN

Retrospective study of prospective collected data.

OBJECTIVE

To analyze the association between intervertebral vacuum phenomenon (IVP) and clinical parameters in patients with degenerative spondylolisthesis.

SUMMARY OF BACKGROUND DATA

IVP is a sign of advanced disc degeneration. The correlation between IVP severity and low back pain in patients with degenerative spondylolisthesis has not been previously analyzed.

METHODS

We retrospectively analyzed patients with degenerative spondylolisthesis who underwent surgery. Vacuum phenomenon was measured on computed tomography scan and classified into mild, moderate, and severe. A lumbar vacuum severity (LVS) scale was developed based on vacuum severity. The associations between IVP at L4/5 and the LVS scale, preoperative and postoperative low back pain, as well as the Oswestry Disability Index was assessed. The association of IVP at L4/5 and the LVS scale and surgical decision-making, defined as decompression alone or decompression and fusion, was assessed through univariable logistic regression analysis.

RESULTS

A total of 167 patients (52.7% female) were included in the study. The median age was 69 years (interquartile range 62-72). Overall, 100 (59.9%) patients underwent decompression and fusion and 67 (40.1%) underwent decompression alone. The univariable regression demonstrated a significantly increased odds ratio (OR) for back pain in patients with more severe IVP at L4/5 [OR=1.69 (95% CI 1.12-2.60), P =0.01]. The univariable regressions demonstrated a significantly increased OR for increased disability with more severe L4/L5 IVP [OR=1.90 (95% CI 1.04-3.76), P =0.04] and with an increased LVS scale [OR=1.17 (95% CI 1.02-1.35), P =0.02]. IVP severity of the L4/L5 were associated with higher indication for fusion surgery.

CONCLUSION

Our study showed that in patients with degenerative spondylolisthesis undergoing surgery, the severity of vacuum phenomenon at L4/L5 was associated with greater preoperative back pain and worse Oswestry Disability Index. Patients with severe IVP were more likely to undergo fusion.

Association between Modic changes and intervertebral vacuum phenomenon severity in patients undergoing percutaneous cement discoplasty

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.