腰椎终板Modic改变与椎间盘退变对应关系及二者与下腰痛关系的分析
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摘要
目的:研究腰椎终板Modic改变类型与椎间盘退变的关系及二者与下腰痛(low back pain,LBP)的关系。方法:选取2016年10—12月间行腰椎MRI检查且合并Modic改变的患者200例。Pfirrmann分级评估腰椎间盘退变。通过电话随访,采用VAS法评估LBP。统计Modic改变及邻近椎间盘退变在下腰段(L4/5及L5/S1水平)的分布情况及关系,及二者与LBP的关系。结果:ModicⅡ型与Ⅱ-Ⅰ型均与轻度椎间盘退变相关(P <0.05)。ModicⅠ-Ⅱ型与轻度及严重椎间盘均相关(P <0.05),而ModicⅠ型与严重椎间盘退变相关(P <0.05)。ModicⅠ型、Ⅱ型及Ⅰ-Ⅱ型与LBP相关(P <0.05)。多因素分析后,严重椎间盘退变(4级)与LBP相关性消失(P> 0.05)。结论:退变程度较高的腰椎间盘易合并ModicⅠ型,ModicⅡ型更常见于退变程度较低的腰椎间盘;退变初始阶段,ModicⅡ型可能向Ⅰ型转换。虽然Modic改变与腰椎间盘退变均与LBP相关,Modic改变的影响可能更直接,而腰椎间盘退变通过Modic改变间接产生影响,因此较弱。
Objective:To study the association between different types of Modic changes and lumbar disc degeneration,as well as their association with low back pain(LBP)further. Methods:Two hundred individuals with lumbar Modic changes had magnetic resonance imaging(MRI)from Oct to Dec 2016. Lumbar disc degeneration was determined by the Pfirrmann grading system. Intensity of LBP was evaluated via a 10-cm visual analog scale(VAS)through telephone interviews. The distribution of Modic changes and disc degeneration in lower segments(L4/5 and L5/S1 level)along with their associations,as well as their association with LBP,was analyzed. Results:Modic Ⅱ and Ⅱ-Ⅰwere associated with lower disc degeneration(grade 3,P < 0.05). Modic Ⅰ-Ⅱ was associated with both lower(grade 3)and severe(grade 4)degenerative discs(P < 0.05),while Modic Ⅰcorrelated to severe disc degeneration(grade 4,P < 0.05). Modic Ⅰ,Ⅱ and Ⅰ-Ⅱ were associated with LBP(P < 0.05). Significant association between severe disc degeneration(grade 4)and LBP lost in multivariate analyses(P > 0.05). Conclusion:Severe lumbar degenerative discs are more likely to be accompanied with Modic Ⅰ,while Modic Ⅱ with lower disc degeneration. At the early stage of degenerative process,Modic Ⅱmay change to Modic Ⅰ. Although both causing LBP,lumbar disc degeneration may exert indirect weak influence on LBP through the direct impact of Modic changes.
Objective:To study the association between different types of Modic changes and lumbar disc degeneration,as well as their association with low back pain(LBP)further. Methods:Two hundred individuals with lumbar Modic changes had magnetic resonance imaging(MRI)from Oct to Dec 2016. Lumbar disc degeneration was determined by the Pfirrmann grading system. Intensity of LBP was evaluated via a 10-cm visual analog scale(VAS)through telephone interviews. The distribution of Modic changes and disc degeneration in lower segments(L4/5 and L5/S1 level)along with their associations,as well as their association with LBP,was analyzed. Results:Modic Ⅱ and Ⅱ-Ⅰwere associated with lower disc degeneration(grade 3,P < 0.05). Modic Ⅰ-Ⅱ was associated with both lower(grade 3)and severe(grade 4)degenerative discs(P < 0.05),while Modic Ⅰcorrelated to severe disc degeneration(grade 4,P < 0.05). Modic Ⅰ,Ⅱ and Ⅰ-Ⅱ were associated with LBP(P < 0.05). Significant association between severe disc degeneration(grade 4)and LBP lost in multivariate analyses(P > 0.05). Conclusion:Severe lumbar degenerative discs are more likely to be accompanied with Modic Ⅰ,while Modic Ⅱ with lower disc degeneration. At the early stage of degenerative process,Modic Ⅱmay change to Modic Ⅰ. Although both causing LBP,lumbar disc degeneration may exert indirect weak influence on LBP through the direct impact of Modic changes.
引文
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[9]Pfirrmann CW,Metzdorf A,Zanetti M,et al.Magnetic resonance classification of lumbar intervertebral disc degeneration[J].Spine(Phila Pa 1976),2001,26(17):1873-1878
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[11]Liu J,Hao L,Suyou L,et al.Biomechanical properties of lumbar endplates and their correlation with MRI fingdings of lumbar degeneration[J].J Biomech,2016,49(4):586-593
[12]Hou Y,Luo Z.A study on the structural properties of the lumbar endplate:histological structure,the effect of bone density,and spinal level[J].Spine(Phila Pa 1976),2009,34(12):E427-E433
[13]Zhao FD,Pollintine P,Hole BD,et al.Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less dense trabecular bone[J].Bone,2009,44(2):372-379
[14]Modic MT,Ross JS.Lumbar degenerative disk disease[J].Radiology,2007,245(1):43-61
[15]Feng Z,Liu Y,Wei W,et al.TypeⅡModic changes may not always represent fat degeneration:A study using MRfat suppression sequence[J].Spine(Phila Pa 1976),2016,41(16):E987-E994
[16]K??p?E,Luoma K,Pitk?niemi J,et al.Correlation of size and type of modic types 1 and 2 lesions with clinical symptoms:a descriptive study in a subgroup of patients with chronic low back pain on the basis of a university hospital patient sample[J].Spine(Phila Pa 1976),2012,37(2):134-139
[17]Luoma K,Vehmas T,Kerttula L,et al.Chronic low back pain in relation to Modic changes,bony endplate lesions,and disc degeneration in a prospective MRI study[J].Eur Spine J,2016,25(9):2873-2881
[18]Ohtori S,Inoue G,Ito T,et al.Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic Type 1 or Type 2 changes on MRI[J].Spine(Phila Pa 1976),2006,31(9):1026-1031
[2]许凤,邹月芬,徐磊,等.磁共振T2WI压脂序列在Modic改变分型中应用价值研究[J].南京医科大学学报(自然科学版),2014,34(11):1609-1613
[3]龚静山,梅东东,朱进,等.腰椎终板Modic改变与椎间盘退变的相关性的定量MRI研究[J].磁共振成像,2017,61(7):514-518
[4]el Barzouhi A,Vleggeert-Lankamp CL,van der Kallen BF,et al.Back pain’s association with vertebral endplate signal changes in sciatica[J].Spine J,2014,14(2):225-233
[5]Jensen OK,Nielsen CV,S?rensen JS,et al.Type 1 Modic changes was a significant risk factor for 1 year outcome in sick-listed low back pain patients:a nested cohort study using magnetic resonance imaging of the lumbar spine[J].Spine J,2014,14(11):2568-2581
[6]Kovacs FM,Arana E,Royuela A,et al.Disc degeneration and chronic low back pain:an association which becomes nonsignificant when endplate changes and disc contour are taken into account[J].Neuroradiology,2014,56(1):25-33
[7]Kerttula L,Luoma K,Vehmas T,et al.Modic type Ichange may predict rapid progressive,deforming disc degeneration:a prospective 1-year follow-up study[J].Eur Spine J,2012,21(6):1135-1142
[8]Luoma K,Vehmas T,Gr?nblad M,et al.Relationship of Modic type 1 change with disc degeneration:a prospective MRI study[J].Skeletal Radiol,2009,38(3):237-244
[9]Pfirrmann CW,Metzdorf A,Zanetti M,et al.Magnetic resonance classification of lumbar intervertebral disc degeneration[J].Spine(Phila Pa 1976),2001,26(17):1873-1878
[10]Teichtahl AJ,Urquhart DM,Wang Y,et al.Lumbar disc degeneration is associated with modic change and high paraspinal fat content-a 3.0T magnetic resonance imaging study[J].BMC Musculoskelet Disord,2016,17(1):439
[11]Liu J,Hao L,Suyou L,et al.Biomechanical properties of lumbar endplates and their correlation with MRI fingdings of lumbar degeneration[J].J Biomech,2016,49(4):586-593
[12]Hou Y,Luo Z.A study on the structural properties of the lumbar endplate:histological structure,the effect of bone density,and spinal level[J].Spine(Phila Pa 1976),2009,34(12):E427-E433
[13]Zhao FD,Pollintine P,Hole BD,et al.Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less dense trabecular bone[J].Bone,2009,44(2):372-379
[14]Modic MT,Ross JS.Lumbar degenerative disk disease[J].Radiology,2007,245(1):43-61
[15]Feng Z,Liu Y,Wei W,et al.TypeⅡModic changes may not always represent fat degeneration:A study using MRfat suppression sequence[J].Spine(Phila Pa 1976),2016,41(16):E987-E994
[16]K??p?E,Luoma K,Pitk?niemi J,et al.Correlation of size and type of modic types 1 and 2 lesions with clinical symptoms:a descriptive study in a subgroup of patients with chronic low back pain on the basis of a university hospital patient sample[J].Spine(Phila Pa 1976),2012,37(2):134-139
[17]Luoma K,Vehmas T,Kerttula L,et al.Chronic low back pain in relation to Modic changes,bony endplate lesions,and disc degeneration in a prospective MRI study[J].Eur Spine J,2016,25(9):2873-2881
[18]Ohtori S,Inoue G,Ito T,et al.Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic Type 1 or Type 2 changes on MRI[J].Spine(Phila Pa 1976),2006,31(9):1026-1031