Eltes Peter Endre, Kiss Laszlo, Bereczki Ferenc, Szoverfi Zsolt, Techens Chloé, Jakab Gabor, Hajnal Benjamin, Varga Peter Pal, Lazary Aron
In Silico Biomechanics Laboratory, National Center for Spinal Disorders, Buda Health Center, Budapest, Hungary.
Department of Spine Surgery, Semmelweis University, Budapest, Hungary.
J Orthop Translat. 2021 Apr 1;28:131-139. doi: 10.1016/j.jot.2021.02.003. eCollection 2021 May.
Percutaneous cement discoplasty (PCD) is a minimally invasive surgical option to treat patients who suffer from the consequences of advanced disc degeneration. As the current two-dimensional methods can inappropriately measure the difference in the complex 3D anatomy of the spinal segment, our aim was to develop and apply a volumetric method to measure the geometrical change in the surgically treated segments.
Prospective clinical and radiological data of 10 patients who underwent single- or multilevel PCD was collected. Pre- and postoperative CT scan-based 3D reconstructions were performed. The injected PMMA (Polymethylmethacrylate) induced lifting of the cranial vertebra and the following volumetric change was measured by subtraction of the geometry of the spinal canal from a pre- and postoperatively predefined cylinder. The associations of the PMMA geometry and the volumetric change of the spinal canal with clinical outcome were determined.
Change in the spinal canal volume (ΔV) due to the surgery proved to be significant (mean ΔV = 2266.5 ± 1172.2 mm, n = 16; p = 0.0004). A significant, positive correlation was found between ΔV, the volume and the surface of the injected PMMA. A strong, significant association between pain intensity (low back and leg pain) and the magnitude of the volumetric increase of the spinal canal was shown (ρ = 0.772, p = 0.009 for LBP and ρ = 0.693, p = 0.026 for LP).
The developed method is accurate, reproducible and applicable for the analysis of any other spinal surgical method. The volume and surface area of the injected PMMA have a predictive power on the extent of the indirect spinal canal decompression. The larger the ΔV the higher clinical benefit was achieved with the PCD procedure.
The developed method has the potential to be integrated into clinical software's to evaluate the efficacy of different surgical procedures based on indirect decompression effect such as PCD, anterior lumbar interbody fusion (ALIF), lateral lumbar interbody fusion (LLIF), oblique lumbar interbody fusion (OLIF), extreme lateral interbody fusion (XLIF). The intraoperative use of the method will allow the surgeon to respond if the decompression does not reach the desired level.
经皮椎体成形术（PCD）是一种微创手术选择，用于治疗患有晚期椎间盘退变后果的患者。由于目前的二维方法可能无法准确测量脊柱节段复杂三维解剖结构的差异，我们的目的是开发并应用一种体积测量方法来测量手术治疗节段的几何变化。
收集10例行单节段或多节段PCD患者的前瞻性临床和放射学数据。进行术前和术后基于CT扫描的三维重建。注入的聚甲基丙烯酸甲酯（PMMA）导致上位椎体抬起，通过从术前和术后预定义的圆柱体中减去椎管几何形状来测量随后的体积变化。确定PMMA几何形状和椎管体积变化与临床结果之间的关联。
手术导致的椎管体积变化（ΔV）被证明具有统计学意义（平均ΔV = 2266.5 ± 1172.2 mm，n = 16；p = 0.0004）。在ΔV、注入的PMMA体积和表面积之间发现了显著的正相关。疼痛强度（腰背痛和腿痛）与椎管体积增加幅度之间显示出强烈的显著关联（腰背痛ρ = 0.772，p = 0.009；腿痛ρ = 0.693，p = 0.026）。
所开发的方法准确、可重复，适用于分析任何其他脊柱手术方法。注入的PMMA的体积和表面积对间接椎管减压程度具有预测能力。ΔV越大，PCD手术获得的临床益处越高。
所开发的方法有可能集成到临床软件中，以评估基于间接减压效果的不同手术程序的疗效，如PCD、前路腰椎椎间融合术（ALIF）、外侧腰椎椎间融合术（LLIF）、斜外侧腰椎椎间融合术（OLIF）、极外侧腰椎椎间融合术（XLIF）。术中使用该方法将使外科医生在减压未达到期望水平时能够做出反应。
