title: Targeted Therapy for Low Back Pain in Elderly Degenerative Lumbar Scoliosis: A Cohort Study.
abstract: METHODS
  Prospective cohort study.
  
  
  OBJECTIVE
  To compare the novel treatment procedure with nonoperative treatment for low back pain (LBP) in elderly patients with degenerative lumbar scoliosis (DLS).
  
  
  BACKGROUND
  Treatment of LBP associated with elderly DLS is controversial. We developed a novel treatment procedure, termed percutaneous intervertebral-vacuum polymethylmethacrylate injection (PIPI).
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Between 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).
  
  
  CONCLUSIONS
  PIPI improved treatment for LBP, with a sustained clinical benefit for at least 2 years.
  
  
  METHODS
  3.
authors.affiliation: *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.
authors.forename: Kiyotaka
authors.initials: K
authors.lastname: Yamada
authors.forename: Toshio
authors.initials: T
authors.lastname: Nakamae
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Kanazawa
authors.forename: Teruaki
authors.initials: T
authors.lastname: Okuda
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Takata
authors.forename: Takashi
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hiramatsu
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Tanaka
authors.forename: Kjell
authors.initials: K
authors.lastname: Olmarker
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Fujimoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001843:Bone Cements; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D017116:Low Back Pain / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D008159:Lumbar Vertebrae; D008297:Male; D019904:Polymethyl Methacrylate / Q000008:administration & dosage*; D011446:Prospective Studies; D012600:Scoliosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D001843:Bone Cements; D019904:Polymethyl Methacrylate