Percutaneous cement discoplasty for the treatment of lumbar degenerative diseases: A system review and meta-analysis

Background: Lumbar degenerative disease (LDD) is one of the main causes of low back pain in the elderly. Surgical treatment usually involves decompression surgery and fusion techniques; however, standard fusion surgery in elderly patients is associated with a higher rate of complications, hospital length of stay, and readmission. Although minimally invasive surgery can reduce risk and shorten hospital stays, it still cannot eliminate the inherent complications of fusion or internal fixation, especially in frail patients. Therefore, it is necessary to find a surgical technology that can not only reduce the risk of operation but also effectively reduce the inherent complications of fusion or internal fixation. The purpose of this study was to evaluate the clinical efficacy and feasibility of percutaneous cement discoplasty for the treatment of LDDs. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search strategy was conducted in PubMed, Web of Science, MEDLINE, Google Scholar, China National Knowledge Infrastructure, China Biology Medicine Disc, and Medical Knowledge Network Citation Database. The quality of the included study was assessed by the Methodological Index for Non-Randomized Studies (MINORS) score. The risk of bias (RoB) about the included study was assessed by the Non-Randomized Studies of Interventions (ROBINS-I) tool. The main results were summarized and analyzed in RevMan 5.4. Results: Finally, we included 10 articles and collected a total of 359 patients, including 171 males (47.63%) and 180 females (52.37%), with an average age of 73.09 +/- 2.74 years. The Methodological Index for Non-Randomized Studies (MINORS) tool was used to assess the articles included in this study, the methodological quality score of 10 retrospective studies varied from 7 to 11. The RoB was assessed using the ROBINS-I tool. Critical RoB was found in 4/10 articles, high RoB was found in 5/10 articles, and intermediate RoB was found in 1/10 articles. The study found that the Visual Analog Scale scores at 1 day (mean difference [MD]: 3.48; 95% confidence interval [CI]: 3.04, 3.93; I-2 = 0%), 3 to 6 months (MD: 4.05; 95% CI: 3.53, 4.56; I-2 = 65%), and 12 to 24 months (MD: 4.00; 95% CI: 3.53, 4.47; I-2 = 45%) after operation were significantly different from those before operation. Meanwhile, the Oswestry Disability Index at 1 day (MD: 42.67; 95% CI: 36.78, 48.57; I-2 = 76%), 3 to 6 months (MD: 42.64; 95% CI: 34.44, 50.83; I-2 = 91%), and 12 to 24 months (MD: 49.22; 95% CI: 42.23, 56.22; I-2 = 83 %) after operation were still significantly different from those before operation. The results with high heterogeneity (I2>50%) were analyzed by sensitivity analysis and subgroup analysis. The results still have significant statistical differences. Conclusion: Studies have shown that percutaneous cement discoplasty is a potential intervention for the treatment of LDDs, which can effectively relieve pain and improve dysfunction.