Biomechanical evaluation of effects of percutaneous cement discoplasty and percutaneous cement interbody fusion on spinal stability_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Shuang ¹ , SHAO Pengfei ² ,  XU Baoshan ³ , LIU Yancheng ¹ , ZHANG Jingyu ¹ , LIU Gang ³ , ZHANG Hongliang ¹ , GUO Zhiwen ¹ , LI Xiaoye ⁴ , HU Yongcheng ¹

1. Department of Bone and Tissue Oncology, Tianjin Hospital, Tianjin, 300211, P. R. China;
2. Department of Neurosurgery, Shijingshan Hospital, Beijing, 100043, P. R. China;
3. Department of Spine Surgery, Tianjin Hospital, Tianjin, 300211, P. R. China;
4. Department of Obstetrics, the Third Central Hospital of Tianjin, Tianjin, 300170, P. R. China;

Corresponding author：

XU Baoshan, Email: baoshanxu99@tmu.edu.cn

Keywords：

Lumbar degeneration; biomechanics; percutaneous cement discoplasty; percutaneous cement interbody fusion; spinal stability

DOI：

10.7507/1002-1892.202206052

Video：

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Objective To investigate the effects of percutaneous cement discoplasty (PCD) and percutaneous cement interbody fusion (PCIF) on spinal stability by in vitro biomechanical tests. Methods Biomechanical test was divided into intact (INT) group, percutaneous lumbar discectomy (PLD) group, PCD group, and PCIF group. Six specimens of L_{4, 5} (including vertebral bodies and intervertebral discs) from fresh male cadavers were taken to prepare PLD, PCD, and PCIF specimens, respectively. Before treatment and after the above treatments, the MTS multi-degree-of-freedom simulation test system was used to conduct the biomechanical test. The intervertebral height of the specimen was measured before and after the axial loading of 300 N, and the difference was calculated. The range of motion (ROM) and stiffness of the spine in flexion, extension, left/right bending, and left/right rotation under a torque of 7.5 Nm were calculated. Results After axial loading, the change of intervertebral height in PLD group was more significant than that in other three groups (P<0.05). Compared with INT group, the ROM in all directions significantly increased and the stiffness significantly decreased in PLD group (P<0.05). Compared with INT group, the ROM of flexion, extension, and left/right rotation in PCD group significantly increased and the stiffness significantly decreased (P<0.05); compared with PLD group, the ROM of flexion, extension, and left/right bending in PCD group significantly decreased and the stiffness significantly increased (P<0.05). Compared with INT group, ROM of left/right bending in PCIF group significantly decreased and stiffness significantly increased (P<0.05); compared with PLD group, the ROM in all directions significantly decreased and the stiffness significantly increased (P<0.05); compared with PCD group, the ROM of flexion, left/right bending, and left/right rotation significantly decreased and stiffness significantly increased (P<0.05). Conclusion Both PCD and PCIF can provide good biomechanical stability. The former mainly affects the stiffness in flexion, extension, and bending, while the latter is more restrictive on lumbar ROM in all directions, especially in bending and rotation.

Citation： LI Shuang, SHAO Pengfei, XU Baoshan, LIU Yancheng, ZHANG Jingyu, LIU Gang, ZHANG Hongliang, GUO Zhiwen, LI Xiaoye, HU Yongcheng. Biomechanical evaluation of effects of percutaneous cement discoplasty and percutaneous cement interbody fusion on spinal stability. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(11): 1407-1412. doi: 10.7507/1002-1892.202206052 Copy

1.	GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 388(10053): 1545-1602.
2.	Lai MKL, Cheung PWH, Cheung JPY. A systematic review of developmental lumbar spinal stenosis. Eur Spine J, 2020, 29(9): 2173-2187.
3.	Adams MA, Dolan P. Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat, 2012, 221(6): 497-506.
4.	Dolan P, Luo J, Pollintine P, et al. Intervertebral disc decompression following endplate damage: implications for disc degeneration depend on spinal level and age. Spine (Phila Pa 1976), 2013, 38(17): 1473-1481.
5.	Puvanesarajah V, Cancienne JM, Werner BC, et al. Perioperative complications associated with posterolateral spine fusions: A study of elderly medicare beneficiaries. Spine (Phila Pa 1976), 2018, 43(1): 16-21.
6.	Mihailidis HG, Manners S, Churilov L, et al. Is spinal surgery safe in octogenarians? ANZ J Surg, 2017, 87(7-8): 605-609.
7.	Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ, 2016, 352: h6234. doi: 10.1136/bmj.h6234.
8.	Deer T, Sayed D, Michels J, et al. A Review of lumbar spinal stenosis with intermittent neurogenic claudication: Disease and diagnosis. Pain Med, 2019, 20(Suppl 2): S32-S44.
9.	Uddin OM, Haque R, Sugrue PA, et al. Cost minimization in treatment of adult degenerative scoliosis. J Neurosurg Spine, 2015, 23(6): 798-806.
10.	Varga PP, Jakab G, Bors IB, et al. Experiences with PMMA cement as a stand-alone intervertebral spacer: Percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs. Orthopade, 2015, 44 Suppl 1: S1-S7.
11.	Kiss L, Varga PP, Szoverfi Z, et al. Indirect foraminal decompression and improvement in the lumbar alignment after percutaneous cement discoplasty. Eur Spine J, 2019, 28(6): 1441-1447.
12.	Tian QH, Lu YY, Sun XQ, et al. Feasibility of percutaneous lumbar discectomy combined with percutaneous cementoplasty for symptomatic lumbar disc herniation with Modic type Ⅰ endplate changes. Pain Physician, 2017, 20(4): E481-E488.
13.	Sola C, Camino Willhuber G, Kido G, et al. Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients. Eur Spine J, 2021, 30(8): 2200-2208.
14.	Camino Willhuber G, Kido G, Pereira Duarte M, et al. Percutaneous cement discoplasty for the treatment of advanced degenerative disc conditions: A case series analysis. Global Spine J, 2020, 10(6): 729-734.
15.	Camino Willhuber G, Bendersky M, De Cicco FL, et al. Development of a new therapy-oriented classification of intervertebral vacuum phenomenon with evaluation of intra- and interobserver reliabilities. Global Spine J, 2021, 11(4): 480-487.
16.	Li S, Xu B, Liu Y, et al. Biomechanical evaluation of spinal column after percutaneous cement discoplasty: A finite element analysis. Orthop Surg, 2022, 14(8): 1853-1863.
17.	何成建, 吴春根, 王涛, 等. 经皮椎间融合成形术治疗节段性脊柱恶性溶骨塌陷一例. 介入放射学杂志, 2014, 23(2): 130-131.
18.	田庆华, 卢莹莹, 宋红梅, 等. 经皮骨水泥融合术治疗强直性脊柱炎伴假关节形成的邻近椎体应力骨折4例. 介入放射学杂志, 2017, 26(6): 551-554.
19.	Xue YD, Zhang ZC, Dai WX. Investigation of preoperative traction followed by percutaneous kyphoplasty combined with percutaneous cement discoplasty for the treatment of severe thoracolumbar osteoporotic vertebral compression fractures. Int J Gen Med, 2021, 14: 6563-6571.
20.	田庆华, 王涛, 何煜, 等. 经皮骨水泥椎间融合术与骨水泥椎间盘成形术治疗老年腰椎间盘突出症的疗效比较. 介入放射学杂志, 2021, 30(3): 264-269.
21.	Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J, 1998, 7(2): 148-154.
22.	Vadapalli S, Robon M, Biyani A, et al. Effect of lumbar interbody cage geometry on construct stability: a cadaveric study. Spine (Phila Pa 1976), 2006, 31(19): 2189-2194.
23.	Kettler A, Schmoelz W, Kast E, et al. In vitro stabilizing effect of a transforaminal compared with two posterior lumbar interbody fusion cages. Spine (Phila Pa 1976), 2005, 30(22): E665-E670.
24.	Techens C, Palanca M, Éltes PE, et al. Testing the impact of discoplasty on the biomechanics of the intervertebral disc with simulated degeneration: An in vitro study. Med Eng Phys, 2020, 84: 51-59.
25.	Grunert P, Moriguchi Y, Grossbard BP, et al. Degenerative changes of the canine cervical spine after discectomy procedures, an in vivo study. BMC Vet Res, 2017, 13(1): 193. doi: 10.1186/s12917-017-1105-5.

1. GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet, 2016, 388(10053): 1545-1602.
2. Lai MKL, Cheung PWH, Cheung JPY. A systematic review of developmental lumbar spinal stenosis. Eur Spine J, 2020, 29(9): 2173-2187.
3. Adams MA, Dolan P. Intervertebral disc degeneration: evidence for two distinct phenotypes. J Anat, 2012, 221(6): 497-506.
4. Dolan P, Luo J, Pollintine P, et al. Intervertebral disc decompression following endplate damage: implications for disc degeneration depend on spinal level and age. Spine (Phila Pa 1976), 2013, 38(17): 1473-1481.
5. Puvanesarajah V, Cancienne JM, Werner BC, et al. Perioperative complications associated with posterolateral spine fusions: A study of elderly medicare beneficiaries. Spine (Phila Pa 1976), 2018, 43(1): 16-21.
6. Mihailidis HG, Manners S, Churilov L, et al. Is spinal surgery safe in octogenarians? ANZ J Surg, 2017, 87(7-8): 605-609.
7. Lurie J, Tomkins-Lane C. Management of lumbar spinal stenosis. BMJ, 2016, 352: h6234. doi: 10.1136/bmj.h6234.
8. Deer T, Sayed D, Michels J, et al. A Review of lumbar spinal stenosis with intermittent neurogenic claudication: Disease and diagnosis. Pain Med, 2019, 20(Suppl 2): S32-S44.
9. Uddin OM, Haque R, Sugrue PA, et al. Cost minimization in treatment of adult degenerative scoliosis. J Neurosurg Spine, 2015, 23(6): 798-806.
10. Varga PP, Jakab G, Bors IB, et al. Experiences with PMMA cement as a stand-alone intervertebral spacer: Percutaneous cement discoplasty in the case of vacuum phenomenon within lumbar intervertebral discs. Orthopade, 2015, 44 Suppl 1: S1-S7.
11. Kiss L, Varga PP, Szoverfi Z, et al. Indirect foraminal decompression and improvement in the lumbar alignment after percutaneous cement discoplasty. Eur Spine J, 2019, 28(6): 1441-1447.
12. Tian QH, Lu YY, Sun XQ, et al. Feasibility of percutaneous lumbar discectomy combined with percutaneous cementoplasty for symptomatic lumbar disc herniation with Modic type Ⅰ endplate changes. Pain Physician, 2017, 20(4): E481-E488.
13. Sola C, Camino Willhuber G, Kido G, et al. Percutaneous cement discoplasty for the treatment of advanced degenerative disk disease in elderly patients. Eur Spine J, 2021, 30(8): 2200-2208.
14. Camino Willhuber G, Kido G, Pereira Duarte M, et al. Percutaneous cement discoplasty for the treatment of advanced degenerative disc conditions: A case series analysis. Global Spine J, 2020, 10(6): 729-734.
15. Camino Willhuber G, Bendersky M, De Cicco FL, et al. Development of a new therapy-oriented classification of intervertebral vacuum phenomenon with evaluation of intra- and interobserver reliabilities. Global Spine J, 2021, 11(4): 480-487.
16. Li S, Xu B, Liu Y, et al. Biomechanical evaluation of spinal column after percutaneous cement discoplasty: A finite element analysis. Orthop Surg, 2022, 14(8): 1853-1863.
17. 何成建, 吴春根, 王涛, 等. 经皮椎间融合成形术治疗节段性脊柱恶性溶骨塌陷一例. 介入放射学杂志, 2014, 23(2): 130-131.
18. 田庆华, 卢莹莹, 宋红梅, 等. 经皮骨水泥融合术治疗强直性脊柱炎伴假关节形成的邻近椎体应力骨折4例. 介入放射学杂志, 2017, 26(6): 551-554.
19. Xue YD, Zhang ZC, Dai WX. Investigation of preoperative traction followed by percutaneous kyphoplasty combined with percutaneous cement discoplasty for the treatment of severe thoracolumbar osteoporotic vertebral compression fractures. Int J Gen Med, 2021, 14: 6563-6571.
20. 田庆华, 王涛, 何煜, 等. 经皮骨水泥椎间融合术与骨水泥椎间盘成形术治疗老年腰椎间盘突出症的疗效比较. 介入放射学杂志, 2021, 30(3): 264-269.
21. Wilke HJ, Wenger K, Claes L. Testing criteria for spinal implants: recommendations for the standardization of in vitro stability testing of spinal implants. Eur Spine J, 1998, 7(2): 148-154.
22. Vadapalli S, Robon M, Biyani A, et al. Effect of lumbar interbody cage geometry on construct stability: a cadaveric study. Spine (Phila Pa 1976), 2006, 31(19): 2189-2194.
23. Kettler A, Schmoelz W, Kast E, et al. In vitro stabilizing effect of a transforaminal compared with two posterior lumbar interbody fusion cages. Spine (Phila Pa 1976), 2005, 30(22): E665-E670.
24. Techens C, Palanca M, Éltes PE, et al. Testing the impact of discoplasty on the biomechanics of the intervertebral disc with simulated degeneration: An in vitro study. Med Eng Phys, 2020, 84: 51-59.
25. Grunert P, Moriguchi Y, Grossbard BP, et al. Degenerative changes of the canine cervical spine after discectomy procedures, an in vivo study. BMC Vet Res, 2017, 13(1): 193. doi: 10.1186/s12917-017-1105-5.

Chinese Journal of Reparative and Reconstructive Surgery

Biomechanical evaluation of effects of percutaneous cement discoplasty and percutaneous cement interbody fusion on spinal stability

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