• Eur Spine J · Jul 2021

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

    • Kiyotaka Yamada, Toshio Nakamae, Kazuyoshi Nakanishi, Naosuke Kamei, Takeshi Hiramatsu, Teruaki Okuda, Takashi Hashimoto, Satoshi Ujigo, Taiki Morisako, Yuji Tsuchikawa, Toshiaki Maruyama, Hiroki Fukui, Nobuo Adachi, Takuro Shimbo, Kjell Olmarker, and Yoshinori Fujimoto.
    • Department of Orthopaedic Surgery, Spine Center, JA Hiroshima General Hospital, 1-3-3 Jigozen, Hatsukaichi, Hiroshima, 738-8503, Japan.
    • Eur Spine J. 2021 Jul 1; 30 (7): 2020-2032.

    PurposeTreatment 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.MethodsPatients 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.ResultsOne 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.ConclusionBone 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.© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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