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. 2023 Mar 6;18(1):172.
doi: 10.1186/s13018-023-03627-6.

Effect of Percutaneous Kyphoplasty on the progression of intervertebral disc degeneration: a retrospective cohort study

Tiemure Wu #  1 , Xiao Han #  1   2 , Wei Tian  3 , Lifang Wang  4 , Chao Wang  4
Affiliations

Effect of Percutaneous Kyphoplasty on the progression of intervertebral disc degeneration: a retrospective cohort study

Tiemure Wu et al. J Orthop Surg Res. .

Abstract

Background: The effect of percutaneous kyphoplasty (PKP) or rather polymethylmethacrylate (PMMA) on adjacent intervertebral discs is still controversial. The evidence from experimental study to clinical study presents bipolar conclusions. In this study, we investigated the effect of PKP on adjacent intervertebral disc degeneration (IDD).

Methods: The experimental group included adjacent intervertebral discs of vertebrae treated with the PKP procedure, and the control group included adjacent intervertebral discs of non-traumatized vertebrae. All measurements were taken by magnetic resonance imaging or X-ray. The intervertebral disc height, the modified Pfirrmann grading system (MPGS), and its differences with Klezl Z and Patel S (ZK and SP) classifications were compared.

Results: A total of 264 intervertebral discs from 66 individuals were selected for the study. The comparison of intervertebral disc height between the two groups pre and post-operatively resulted in a p-value of > 0.05. No significant change was observed in the adjacent discs in the control groups post-operatively. Post-operatively, the mean Ridit increased significantly from 0.413 to 0.587 in the upper disc and from 0.404 to 0.595 in the lower disc in the experimental group. The comparison of MPGS differences showed that the predominant value was 0 in the Low-grade leaks group and 1 in the Medium and high-grade leaks group.

Conclusions: The PKP procedure can accelerate adjacent IDD, but it does not cause disc height changes in the early stage. The quantity of cement leaking into the disc space positively correlated with the rate of disc degeneration progression.

Keywords: Cement leak; Intervertebral disc degeneration; Percutaneous Kyphoplasty; Polymethylmethacrylate.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
MRI of spine assessments. 0: PKP vertebral. 1. Upper disc of the kyphoplasty vertebral group (KVG). 2. Lower disc of the KVG. 3. Upper disc of the non-traumatized vertebral group (NTVG). 4. Lower disc of the NTVG
Fig. 2
Fig. 2
An image reference panel showing the increasing severity of disc degeneration. The pertinent features of each grade are described in Table 1. Three images reflect the inherent variability across each grade. This figure is reproduced from Griffith, J. F. et al.21
Fig. 3
Fig. 3
Intervertebral disc height measurement. The height of the disc is approximately equal to the area (S1) divided by the length of the disc (a)
Fig. 4
Fig. 4
The ZK and SP classification. This figure is reproduced from Jamjoom et al. [22]. The ZK and SP classification system is based on the leakage of cement into the disc space. a: Grade I, cement leakage into the disc space was considered minimal/cloud. b: Grade II, cement leakage filling < 20% of the disc space. c: Grade III, cement leakage filling 20–40% of the disc space. d: Grade IV, cement leakage filling > 40% of the disc space
Fig. 5
Fig. 5
Comparison of pre- and post-operative Modified Pfirrmann Grading System grades between the experimental and control groups (Ridit analysis). Disc degeneration post-operatively was demonstrated in the experimental group, but was not observed in the control group. A: Upper disc of the experimental group; B: Lower disc of the experimental group; C: Upper disc of the control group; D: Lower disc of the control group Pre Preoperative, Post Post-operative
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