• Kiyotaka Yamada, Toshio Nakamae, Takuro Shimbo, Toshikatsu Kanazawa, Teruaki Okuda, Haruhiko Takata, Takashi Hashimoto, Takeshi Hiramatsu, Nobuhiro Tanaka, Kjell Olmarker, and Yoshinori Fujimoto.
• *Department of Orthopaedic Surgery, JA Hiroshima General Hospital, Hiroshima, Japan †Ohta Nishinouchi Hospital, Fukushima, Japan ‡Department of Orthopaedic Surgery, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan §Muskuloskeletal Research, Department of Medical Chemistry and Cellbiology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
• Spine. 2016 May 1; 41 (10): 872-9.

Study DesignProspective cohort study.ObjectiveTo compare the novel treatment procedure with nonoperative treatment for low back pain (LBP) in elderly patients with degenerative lumbar scoliosis (DLS).Summary Of Background DataTreatment of LBP associated with elderly DLS is controversial. We developed a novel treatment procedure, termed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI).MethodsWe included patients with de novo DLS aged ≥65 years who had LBP with a visual analogue scale (VAS) score of >50 for ≥6 months with intervertebral vacuum and vertebral bone marrow edema (BME) defined on fat-saturated T2-weighted or gadolinium-enhanced T1-weighted magnetic resonance imaging. The primary outcomes were evaluated using the VAS score and modified Oswestry Disability Index (ODI). As an objective measurement, we scored BME on magnetic resonance imaging.ResultsBetween August 2004 and July 2011, 109 patients underwent PIPI and 53 received nonoperative treatment. At 1 month, mean improvements in VAS scores were -55.3 (95% CI, -60.5 to -50.1) and -1.9 (CI, -7.7 to 3.8) and mean improvements in ODI were -22.7 (CI, -27.3 to -18.2) and -0.6 (CI, -6.6 to 5.4) for the PIPI and nonoperative groups, respectively. At 2 years, mean improvements in VAS scores were -52.2 (CI, -59.9 to -44.4) and -4.0 (CI, -10.9 to 3.0) and mean improvements in ODI were -20.7 (CI, -27.3 to -14.5) and -1.0 (CI, -7.7 to 5.7) for the PIPI and nonoperative groups, respectively. BME substantially decreased in the PIPI group compared with the nonoperative group (P <0.001) and correlated with VAS score and ODI improvements (VAS score: r = 0.502, P <0.001; ODI: r = 0.372, P <0.001).ConclusionPIPI improved treatment for LBP, with a sustained clinical benefit for at least 2 years.Level Of Evidence3.

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