Adjacent disc height reduction and clinical outcome after intradiscal cement leakage

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Fig. 1
Measurement of disc height (A) and disc diameter (B). Anterior disc height (Ha) and posterior disc height (Hp) were the shortest distances between the anterior and posterior edges of the neighboring endplates, respectively. Lines a and b (black lines) were drawn from the anterior and posterior endpoints of the superior vertebral endplate to the inferior, respectively. Disc diameter (DM, white line) was measured between the midpoints of line a and b.
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Fig. 2
A 70-year-old female who suffered from a vertebral compression fracture at T12. Lateral radiograph 19 months postoperatively (B) shows disc height reduction compared with the image one day after surgery (A). The Farfan index was 34.55% and 24.97% on lateral radiograph one day after surgery (A) and 19 months postoperatively (B), respectively.

Table 1

Characteristics of patients, fractured vertebrae and surgeries.

	With Intradiscal Leakage (n=20)	Without Intradiscal Leakage (n=104)	P value
Patient characteristics
Age, year	64.20±8.024	65.78±8.13	.427
Sex, female	17/20	86/104	1.000
BMD (T-score)	-2.88±0.44	-2.72±0.39	.105
History of smoking	3/20	15/104	1.000
History of drinking alcohol	1/20	11/104	.719
Follow-up time, months	19.80±2.95	20.71±3.61	.290
Fracture characteristics
Intravertebral cleft	4/20	8/104	.196
Fracture age, wk			.365
≤6	14	83
6-12	4	12
≥12	2	9
Fracture location			1.000
Thoracolumbar region (T11-L2)	18	92
Lower lumbar region (L3-L5)	2	12
Fracture type			.480
Wedge	14	85
Biconcave	4	12
Crush	2	7
Fracture severity grade (%)			.428
≤25	7	43
25-40	8	44
≥40	5	17
Endplate fracture			.078
absence	2	30
presence	18	74
Surgical characteristics
Total PMMA volume, ml	5.78±0.80	5.08±0.97	.003^*

Table 2

Baseline disc characteristics.

	With Intradiscal Leakage (n=20)	Without Intradiscal Leakage (n=104)	P value
Preoperative modified Pfirrmann disc grade			.799
Grade 1	0	0
Grade 2	1	10
Grade 3	14	68
Grade 4	4	19
Grade 5	1	7
Baseline anterior disc height, mm	8.11±2.50	8.49±3.23	.865
Baseline posterior disc height, mm	4.24±1.15	4.19±1.92	.194
Baseline disc diameter, mm	38.75±4.57	40.71±4.30	.066
Baseline Farfan index (%)	31.87±8.01	30.51±8.77	.521

Table 3

The results of disc height measurement.

Group	Anterior disc height (mm)			Posterior disc height (mm)			Disc diameter (mm)			Farfan index (%)			DHR	DHR rate (%)
	Post	Last	P	Post	Last	P	Post	Last	P	Post	Last	P
With Intradiscal Leakage	8.11±2.50	5.62±2.11	<0.001	4.24±1.15	2.92±0.93	<0.001	38.75±4.57	38.77±4.64	0.881	31.87±8.01	22.68±7.20	<0.001	9.19±2.89	29.39±7.90
Without Intradiscal Leakage	8.49±3.23	7.39±2.99	<0.001	4.19±1.92	3.66±1.75	<0.001	40.71±4.30	40.66±4.31	<0.001	30.51±8.77	26.63±8.12	<0.001	3.88±2.70	12.75±8.18
Between Group P	0.865	0.006		0.194	0.096		0.102	0.128		0.283	0.036		<0.001	<0.001

Abbreviations: pos, one day after surgery (baseline); last, last follow-up; DHR, disc height reduction; DHR rate, disc height reduction rate.

Table 4

Clinical assessment using visual analog scale and Oswestry Disability Index.

		With Intradiscal Leakage (n=20)	Without Intradiscal Leakage (n=104)
Visual analogue scale	preoperative	7.15±0.93	7.17±1.04
	pos	2.30±0.73 ^{^a}	2.36±0.84^{^a}
	last	2.80±0.62^{^a}	2.60±0.65 ^{^a}
Oswestry disability index	preoperative	73.80±12.31	69.90±13.69
	pos	28.50±4.35 ^{^a}	27.23±5.91 ^{^a}
	last	30.90±3.28 ^{^a}	29.25±4.69 ^{^a}