Percutaneous Cement Discoplasty for Degenerative Low Back Pain with Vacuum Phenomenon: A Multicentric Study with a Minimum of 2 Years of Follow-Up.

BACKGROUND: To report clinical results after percutaneous cement discoplasty (PCD) in a multicentric case series with a minimum of 2 years of follow-up. METHODS: Between December 2014 and January 2019, 180 patients with low back pain and advanced degeneration were treated with percutaneous discoplasty in 2 centers. The inclusion criteria were as follows: patients 65 years or older, with mechanical low back pain with or without spinal stenosis, who did not respond to conservative management. Patients were divided into 3 groups: group 1: patients without previous spine surgeries who underwent PCD, group 2: patients with previous spine surgeries who underwent PCD, and group 3: patients with/without previous surgery who underwent PCD plus decompression surgery. Clinical and radiological analyses were performed as well as complication and readmission rates. RESULTS: A total of 156 patients (74% female; mean age, 75.8 ± 5.7 years; mean body mass index, 29.9 ± 5.2) were included in our study. Overall preoperative visual analog score (VAS) and Oswestry Disability Index (ODI) were 7.8 ± 0.9 and 68.1 ± 9.6, respectively. At 2 years of follow-up, mean VAS improvement was 3.56 (95% confidence interval: 3.92-3.20; P < 0.0001) and mean ODI improvement was 17.18 (95% confidence interval: 19.52-14.85; P < 0.0001), showing a significant and sustained improvement in both scores. In addition, 84% of patients reached both VAS and ODI minimum important clinical difference at the final follow-up. Finally, 5.7% of patients suffered major complications 30 days postoperatively. CONCLUSIONS: PCD showed significant improvement of VAS and ODI scores at 2 years of follow-up with relatively low rate of complications.

Clinical and radiological outcomes after stand-alone ALIF for single L5-S1 degenerative discopathy using a PEEK cage filled with hydroxyapatite nanoparticles without bone graft.

OBJECTIVE: Recent improvements in cage designs with integral fixation and screw attachments have made stand-alone ALIF a viable option with several possible advantages. The aim of this study was to confirm the efficacy and safety of a PEEK cage filled with hydroxyapatite nanoparticles without adding a bone graft for stand-alone ALIF in the treatment of L5-S1 isolated degenerative disc discopathy (DDD). PATIENTS AND METHODS: Sixty-five patients who required surgery for DDD were evaluated. Clinical outcome evaluations included back and leg pain (VAS), disability (Oswestry Disability Index), and patient satisfaction (Macnab's criteria). Radiological outcomes include the assessment of disc height, the L5-S1 intervertebral disc angle, and anterior intervertebral fusion through standard and functional sagittal X-rays of the lumbar spine. Clinical and radiological measurements were assessed 2, 6, 12, and 24 months after surgery. RESULTS: Clinical outcomes improved progressively and stabilized from 12- to 24-month follow-up. Final postoperative ODI scores showed a notable improvement (95%CI = 36.1-48.9 points; p < .001). Similarly, 24-month postoperative VAS scores revealed a significant decrease in pain (95%CI = 5.4-6.2; p < .001). The fusion rate was 95.4%. Anterior disc height was restored from 4.1 ±â€¯3.2 mm at baseline to 9.5 ±â€¯1.6 mm in the immediate postoperative period (p < .001). A small collapse (17.9%) of the disc height was detected from the 2- and 24-month follow-ups. Cage subsidence (more than 3 mm collapse) was detected in 4 cases (6.2%) and was related to cage size (more than 11 mm height; P < .05). There were no serious bone substitute-related adverse events and no revision surgeries. CONCLUSION: Stand-alone anterior lumbar interbody fusion using hydroxyapatite nanoparticles without an autologous bone graft is an effective and safe treatment option for L5-S1 degenerative pathology. Clinical outcomes were very satisfactory with a high fusion rate.

The "pendulum law" - how to explain the column shape based on common anomalies? part ii / La "ley del péndulo" - ¿cómo explicar la forma de la columna en función de las anomalías comunes? parte ii / A "lei do pêndulo" - como explicar a forma da coluna com base em anomalias comuns? parte ii

ABSTRACT In Part I, the author defines an organizational law of the body schema: the "pendulum law", describing an ideal biomechanical structure of the spine. Thus, he shows how the common variations and anomalies, whether isolated or associated, modify the standard biomechanical scheme. The variations of isolated "curl/roll up" of the sacrum. Anomalies of the lumbosacral joint in the sagittal (LSS) and/or rotational (LSR) plan. Anomalies of stabilization of the capsule of the hip joint and the sacro-diaphyseal angle. Specific anomalies with grade 1 spondylolysis (SL). Segmental anomalies of the vertebral discs in flexion (Rx). Associated anomalies (SL + Rx + ASL= Rx). The interest of studying the impact on the vertical construction of the vertebral column, according to the "ideal" scheme is to establish the physiological limits of this gravitational law, to identify the anomalies, to classify schemes and types, and the biomechanical degenerative consequences.

RESUMEN En la Parte I, el autor define una ley organizacional del esquema corporal: la "ley del péndulo", describiendo una estructura biomecánica ideal de la columna. De esta forma, demuestra como las variaciones y anomalías comunes, ya sean aisladas o asociadas, modifican el esquema biomecánico estándar. Las variaciones de "enrollamiento" aislado del sacro. Las anomalías de la articulación lumbosacra en el plan sagital (ALS) y/o rotatoria (ALSR). Las anomalías de estabilización de la cápsula de la articulación de la cadera y del ángulo sacro-diafisario. Las anomalías específicas con espondilólisis (SL) de grado 1. Las anomalías segmentarias de los discos vertebrales en flexión (Rx). Las anomalías asociadas (SL+Rx+ASL= Rx). El interés de estudiar el impacto sobre la construcción vertical de la columna, en función del esquema "ideal" es el de establecer los límites fisiológicos de esta ley gravitacional, de identificar las anomalías, de catalogar esquemas y tipos y las consecuencias biomecánicas degenerativas.

RESUMO Na Parte I, o autor define uma lei organizacional do esquema corporal: a "lei do pêndulo", que descreve uma estrutura biomecânica ideal da coluna vertebral. Assim, demonstra como as variações e alterações comuns, sejam isoladas ou associadas, modificam o esquema biomecânico padrão. Variações de "enrolamento" isolado do sacro. Anomalias da articulação lombossacral no plano sagital (LSS) e/ou rotacional (LSR). Anomalia de estabilização da cápsula da articulação do quadril e do ângulo sacro-diafisário. Anomalias específicas com espondilólise (SL) de grau 1. Anomalias segmentares dos discos vertebrais em flexão (Rx). Anomalias associadas (SL + Rx + ASL= Rx). O interesse de estudar o impacto sobre a construção vertical da coluna vertebral, de acordo com o esquema "ideal" é estabelecer os limites fisiológicos dessa lei gravitacional, identificar as anomalias, classificar esquemas e tipos e as consequências biomecânicas degenerativas.

The "pendulum law" - how to explain the spinal shape? part i / A "lei do pêndulo" - como explicar a forma da coluna? parte i / La "ley del péndulo" - ¿cómo explicar la forma de la columna? parte i

ABSTRACT The author uses the classical parameters that allow studying the sagittal form of the spine, following a vertebral semantics (lordosis, kyphosis, spinopelvic parameters, and sagittal balance). Then he proposes a very different perspective that analyzes the shape of the column, not in the sagittal-coronal plane but in the vertical plane, that is, integrating gravity as a three-dimensional construction axis. Beginning with an analysis of the global body scheme of which the column is part, the muscular synergies are introduced using reference points, defining tension lines, anatomical and functional arches, highlighting the importance of the respiratory function that stabilizes the shape of the thoracolumbar spine. This shows that, whatever the pelvic or frequent anomalies, the biomechanical scheme depends on a single unique law related to gravity: the "pendulum law". This allows us to define an ideal shaped spine, in comparison to different models, evoking the semantic practical and therapeutic interest of such a perspective.

RESUMO O autor emprega os parâmetros clássicos que permitem estudar a forma sagital da coluna, seguindo a semântica vertebral (lordose, cifose, parâmetros espinopélvicos, equilíbrio sagital). A seguir, propõe uma perspectiva totalmente diferente que analisa a forma da coluna, não no plano sagital-coronal, mas sim no plano vertical, ou seja, integrando a gravidade como o eixo de construção tridimensional. Começando com uma análise do esquema global do corpo, do qual a coluna faz parte, as sinergias musculares são introduzidas usando pontos de referência, definindo linhas de tensão, arcos anatômicos e funcionais, enfatizando a importância da função respiratória que estabiliza a forma da coluna toracolombar. Isso mostra que, sejam quais forem as anomalias pélvicas ou frequentes, o esquema biomecânico depende de uma única lei relacionada com a gravidade: a "lei do pêndulo". Isso nos permite definir a forma ideal da coluna, em comparação com modelos distintos, evocando o interesse semântico prático e terapêutico desse tipo de perspectiva.

RESUMEN El autor utiliza los parámetros clásicos que permiten estudiar la forma sagital de la columna, siguiendo una semántica vertebral (lordosis, cifosis, parámetros espinopélvicos, balance sagital). Luego propone una perspectiva totalmente diferente que analiza la forma de la columna, no en el plan sagital-coronal sino que en el plan vertical, es decir, integrando la gravedad como eje de construcción tridimensional. Comenzando por un análisis del esquema corporal global del cual forma parte la columna, se introducen las sinergias musculares utilizando puntos de referencia, definiendo líneas de tensión, arcos anatómicos y funcionales, resaltando la importancia de la función respiratoria estabilizadora de la forma de la columna vertebral toracolumbar. Esto demuestra que, cualesquiera que sean las anomalías pélvicas o frecuentes, el esquema biomecánico depende de una única ley única vinculada a la gravedad: la "ley del péndulo". Esto permite definir una columna vertebral de referencia, en comparación a modelos distintos, evocando el interés semántico práctico y terapéutico de tal perspectiva.