Cement discoplasty for degenerative low back pain: a delphi consensus survey of expert opinion

Cement discoplasty (CD) is a spine surgery technique involving percutaneous or open polymethylmethacrylate injection into an empty degenerative vacuum disc in the lumbar spine. Although cement acts optimally under compression, the concept of stabilizing without fusing remains uncertain regarding its clinical effectiveness. Despite multiple outcome studies and several meta-analyses, CD continues to be controversial, poorly understood, and not integrated into mainstream surgical practice. Establishing a unified platform is necessary to clarify indications and technique.

International peer-reviewed experts in CD were invited to participate in a three-round Delphi process using independent self-administered questionnaires. Fifty statements were developed across five categories: Rationale, Imaging Studies, Technical Aspects, Clinical Indications, and Postoperative Management. Responses were graded on a five-point Likert scale. The survey underwent pilot testing by two experts to ensure face validity and clarity. Consensus was defined as ≥ 80% agreement.

Ten experts completed all three rounds. Agreed rationale included restoring anterior column loading, stabilization through annular ligamentotaxis, and increasing foraminal height. Indications included facet arthrosis and mild coronal deformity (Cobb 10-30°). Radiographs and CT were considered appropriate to confirm vacuum disc and subchondral endplate sclerosis. Accepted trajectories were trans- or extra-pedicular, with combined approaches permitted when decompression for stenosis was required. Early mobilization was unanimously recommended.

Consensus was reached on essential aspects of this little-known procedure, including rationale, imaging, technical considerations, clinical indications, and postoperative management. This foundation may improve understanding and guide future adoption of cement discoplasty.