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Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis

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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.

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Acknowledgments

The authors thank Dr. John G Heller for editing our manuscript, Dr. Reisuke Nishihara for examining the image findings.

Funding

We have no funding for this research.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Spine Center, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan

    Kiyotaka Yamada, Takeshi Hiramatsu, Teruaki Okuda, Takashi Hashimoto, Satoshi Ujigo, Toshiaki Maruyama, Hiroki Fukui & Yoshinori Fujimoto

  2. Department of Orthopaedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan

    Toshio Nakamae, Naosuke Kamei, Taiki Morisako, Yuji Tsuchikawa & Nobuo Adachi

  3. Department of Orthopaedic Surgery, Nihon University School of Medicine, Tokyo, Japan

    Kazuyoshi Nakanishi

  4. Ohta Nishinouchi Hospital, Fukushima, Japan

    Takuro Shimbo

  5. Department of Medical Chemistry and Cell Biology, Institute of Biomedicine, Muskuloskeletal Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Kjell Olmarker

Authors
  1. Kiyotaka Yamada
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  2. Toshio Nakamae
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Contributions

Yoshinori Fujimoto and Kiyotaka Yamada wrote and prepared the manuscript, and all of the authors participated in the study design. All authors have read, reviewed, and approved the article.

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Correspondence to Yoshinori Fujimoto.

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Yamada, K., Nakamae, T., Nakanishi, K. et al. Long-term outcome of targeted therapy for low back pain in elderly degenerative lumbar scoliosis. Eur Spine J 30, 2020–2032 (2021). https://doi.org/10.1007/s00586-021-06805-4

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