CL_VII_L: Clinical Medicine VII. Lectures
Kristóf Koch MD, National Center for Spinal Disorders, Budapest
Zsolt Szövérfi MD, PhD, National Center for Spinal Disorders, Budapest
Introduction Percutaneous cement discoplasty (PCD) was introduced to treat symptomatic vertical instability of the lumbar spine. Being a minimally invasive surgical procedure, it is an ideal treatment option for elderly patients with comorbidities, where open surgeries are contraindicated. Due to the low number of relevant publications the early and late clinical outcome (complications, hospital stay, reoperation rate, late effects) is not well described.
Purpose The aim of present study is to summarize the early and late complications after PCD and to identify factors that predict the chance of cement leakage and of prolonged length of hospital stay (LOS).
Methods 344 patients were treated with PCD in the study period. 57 patients had concomitant procedure like decompression or vertebroplasty (PCD+). Clinical features and postoperative complications were analysed based on the two subgroups, while perioperative factors on cement leakage and on LOS were identified with linear and logistic regression using the whole cohort.
Results In PCD group 37 (12.9%) patients had symptomatic and 76 (26.5%) had asymptomatic cement leakage, while in PCD+ group symptomatic leakage was found at 3 (5.3%) patient and asymptomatic leakage at 6 (10.5%) patients. The majority of patients were treated conservatively, the reoperation rate for PCD was 9.4%, and 10.5% for the PCD+ group. Age, BMI, type of PMMA and operated levels were identified as risk factors of cement leakage after PCD procedure (p<0.01, c-index=0.795). Age, type of procedure, BMI, Charlson score, reoperation and postoperative symptoms increased significantly the LOS days in our cohort (p<0.01).
Conclusion Current study shows that the main complication after PCD is cement leakage, however it is often asymptomatic. The occurrence of the leakage is influenced by high age, high BMI, high viscosity PMMA and more operated segments. Furthermore, we identified high age, high BMI, Charlson score, reoperation due to cement leakage, concomitant surgical procedures and postoperative symptoms as risk factors of prolonged on LOS after PCD.
Semmelweis University, Károly Rácz Doctoral School of Clinical Medicine