腰椎MRI评价椎间小关节积液与退变性腰椎滑脱稳定性的相关性
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摘要
背景:临床中对腰椎滑脱患者腰椎稳定性的诊断多借助腰椎侧位屈伸X射线,但该检查存在一定的局限,因此寻找可靠的腰椎稳定性预测指标十分必要。目的:通过回顾患者影像学资料,分析退变性腰椎滑脱患者腰椎椎间小关节积液是否与腰椎稳定性存在相关性。方法:回顾性分析2016年12月至2018年1月在天津市人民医院脊柱外科就诊的L4-5节段腰椎退变性滑脱患者共108例,所有患者对测量方案知情同意,且得到医院伦理委员会批准。根据其滑脱节段的腰椎MRI中是否出现椎间小关节腔内积液将患者分为无积液组55例,有积液组53例,并对2组进行对比分析。对有积液组中的双侧椎间小关节积液宽度和与矢状位椎体动态滑移指数、椎体旋转度、双侧椎间小关节退变指数和及椎间盘退变指数分别进行相关性分析。结果与结论:①无积液组的失稳率低于有积液组,动态滑移量、动态滑移指数及矢状位旋转度均小于有积液组,椎间小关节及椎间盘退变程度均高于有积液组,差异均有显著性意义(P=0.000);②对于有积液组的相关性分析,双侧椎间小关节积液宽度和分别与矢状位椎体动态滑移指数、矢状位椎体旋转度成线性正相关(r=0.710,P=0.000;r=0.452,P=0.001);双侧椎间小关节积液宽度和分别与双侧椎间小关节退变指数和、椎间盘退变指数成负相关(r=-0.630,P=0.000;r=-0.648,P=0.000);③提示退变性腰椎滑脱症患者腰椎MRI上存在椎间小关节积液表现可提示滑脱不稳定,滑脱节段椎间小关节总积液量与腰椎滑移不稳定性、旋转不稳定性成正相关,与双侧椎间小关节退变程度、椎间盘退变程度成负相关。
BACKGROUND: Clinically, the diagnosis of lumbar spine stability in patients with lumbar spondylolisthesis is mostly based on lumbar lateral flexion and extension X-ray, but this examination has certain limitations, so it is necessary to find a reliable predictor of lumbar stability.OBJECTIVE: To evaluate the correlation between facet joint effusion and lumbar stability after interspinous and degenerative lumbar spondylolisthesis by retrospectively analyzing patients' imaging data.METHODS: A total of 108 patients with L4-5 lumbar spondylolisthesis in Department of Spinal Surgery, Tianjin People's Hospital from December 2016 to January 2018 were analyzed retrospectively. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into non-effusion group(n=55) and effusion group(n=53) according to the presence and absence of intra-articular effusion of intervertebral facet joint based on lumbar MRI. The two groups were comparatively analyzed. In the effusion group, the correlation between the effusion width of bilateral facet joint and the dynamic slip index of sagittal vertebra, the rotation degree of sagittal vertebral body, bilateral degeneration index of facet joint, intervertebral disc degeneration index were statistically analyzed separately.RESULTS AND CONCLUSION:(1) Compared with the effusion group, the instability rate was lower; the dynamic slip volume, dynamic slip index, and the sagittal rotation degree were less; and the degeneration degree of facet joint and intervertebral disc was higher in the non-effusion group(P=0.000).(2) There was a linear positive correlation between the width of effusion of bilateral facet joints and the dynamic slip index of the sagittal vertebral body, the rotation degree of the sagittal vertebral body in the effusion group( r=0.710, P=0.000;r=0.452, P=0.001). There was a linear negative correlation between the width of effusion of bilateral facet joints and the degeneration index of bilateral facet joint and intervertebral disc in the effusion group(r=-0.630, P=0.000; r=-0.648, P=0.000).(3) The presence of effusion in the facet joint on MRI in degenerative lumbar spondylolisthesis patients suggested instability. The total fluid a ccumulation of the facet joint in the segment of spondylolisthesis was positively correlated with the translation instability and rotation insta bility of the lumbar vertebrae. There was a negative correlation between the volume of effusion of bilateral face t joints and the degree of degeneration of intervertebral disc and facet joints.
BACKGROUND: Clinically, the diagnosis of lumbar spine stability in patients with lumbar spondylolisthesis is mostly based on lumbar lateral flexion and extension X-ray, but this examination has certain limitations, so it is necessary to find a reliable predictor of lumbar stability.OBJECTIVE: To evaluate the correlation between facet joint effusion and lumbar stability after interspinous and degenerative lumbar spondylolisthesis by retrospectively analyzing patients' imaging data.METHODS: A total of 108 patients with L4-5 lumbar spondylolisthesis in Department of Spinal Surgery, Tianjin People's Hospital from December 2016 to January 2018 were analyzed retrospectively. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into non-effusion group(n=55) and effusion group(n=53) according to the presence and absence of intra-articular effusion of intervertebral facet joint based on lumbar MRI. The two groups were comparatively analyzed. In the effusion group, the correlation between the effusion width of bilateral facet joint and the dynamic slip index of sagittal vertebra, the rotation degree of sagittal vertebral body, bilateral degeneration index of facet joint, intervertebral disc degeneration index were statistically analyzed separately.RESULTS AND CONCLUSION:(1) Compared with the effusion group, the instability rate was lower; the dynamic slip volume, dynamic slip index, and the sagittal rotation degree were less; and the degeneration degree of facet joint and intervertebral disc was higher in the non-effusion group(P=0.000).(2) There was a linear positive correlation between the width of effusion of bilateral facet joints and the dynamic slip index of the sagittal vertebral body, the rotation degree of the sagittal vertebral body in the effusion group( r=0.710, P=0.000;r=0.452, P=0.001). There was a linear negative correlation between the width of effusion of bilateral facet joints and the degeneration index of bilateral facet joint and intervertebral disc in the effusion group(r=-0.630, P=0.000; r=-0.648, P=0.000).(3) The presence of effusion in the facet joint on MRI in degenerative lumbar spondylolisthesis patients suggested instability. The total fluid a ccumulation of the facet joint in the segment of spondylolisthesis was positively correlated with the translation instability and rotation insta bility of the lumbar vertebrae. There was a negative correlation between the volume of effusion of bilateral face t joints and the degree of degeneration of intervertebral disc and facet joints.
引文
[1]Matz PG,Meagher RJ,Lamer T,et al.Guideline summary review:An evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spondylolisthesis.Spine J.2016;16(3):439-448.
[2]王立侠,李龙鹏,李涛,等.腰椎滑脱的X线诊断价值[J].中国医药导刊,2015,17(9):918-919.
[3]沈剑粦,王宸.退行性腰椎不稳诊断的研究进展[J].东南大学学报(医学版),2013,32(1):118-121.
[4]Hipp JA,Guyer RD,Zigler JE,et al.Development of a novel radiographic measure of lumbar instability and validation using the facet fluid sign.Int J Spine Surg.2015;9:37.
[5]Chaput C,Padon D,Rush J,et al.The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis.Spine(Phila Pa 1976).2007;32(17):1883-1887.
[6]任东风,侯树勋,吴文闻,等.MRI腰椎小关节积液影像对退行性腰椎动态不稳的预测价值[J].中国疼痛医学杂志,2011,17(3):131-133.
[7]Steiger F,Becker HJ,Standaert CJ,et al.Surgery in lumbar degenerative spondylolisthesis:indications,outcomes and complications.A systematic review.Eur Spine J.2014;23(5):945-973.
[8]Grogan J,Nowicki BH,Schmidt TA,et al.Lumbar facet joint tropism does not accelerate degeneration of the facet joints.AJNR Am J Neuroradiol.1997;18(7):1325-1329.
[9]Griffith JF,Wang YX,Antonio GE,et al.Modified Pfirrmann grading system for lumbar intervertebral disc degeneration.Spine(Phila Pa 1976).2007;32(24):E708-E712.
[10]Boden SD,Wiesel SW.Lumbosacral segmental motion in normal individuals.Have we been measuring instability properly?Spine(Phila Pa 1976).1990;15(6):571-576.
[11]Denis F.The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.Spine(Phila Pa 1976).1983;8(8):817-831.
[12]Alqarni AM,Schneiders AG,Hendrick PA.Clinical tests to diagnose lumbar segmental instability:a systematic review.JOrthop Sports Phys Ther.2011;41(3):130-140.
[13]Rihn JA,Lee JY,Khan M,et al.Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease?Spine(Phila Pa 1976).2007;32(14):1555-1560.
[14]Cho BY,Murovic JA,Park J.Imaging correlation of the degree of degenerative L4-5 spondylolisthesis with the corresponding amount of facet fluid.J Neurosurg Spine.2009;11(5):614-619.
[15]刘大海,刘爽,牟建辉,等.仰卧位MRI测量小关节积液对腰椎退变性滑脱稳定性诊断意义的研究[J].中国实验诊断学,2015,19(9):1564-1565.
[16]Lattig F,Fekete TF,Kleinstuck FS,et al.Lumbar facet joint effusion on MRI as a sign of unstable degenerative spondylolisthesis:should it influence the treatment decision?J Spinal Disord Tech.2015;8(3):95-100.
[17]Fujii W,Kawahito Y,Nagahara H,et al.Monocarboxylate transporter 4,associated with the acidification of synovial fluid,is a novel therapeutic target for inflammatory arthritis.Arthritis Rheumatol.2015;67(11):2888-2896.
[18]Sellam J,Berenbaum F.The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis.Nat Rev Rheumatol.2010;6(11):625-635.
[19]Kirkaldy-Willis WH,Farfan HF.Instability of the lumbar spine.Clin Orthop Relat Res 1982;165:110-123.
[20]Vanhoenacker FM,Eyselbergs M,Cotten A."Spinal degeneration:beyond degenerative disc disease":how to discriminate degeneration from spondylarthropathies?Neuroradiology.2011;53 Suppl 1:S175-S179.
[21]Videman T,Battie MC,Parent E,et al.Progression and determinants of quantitative magnetic resonance imaging measures of lumbar disc degeneration:a five-year follow-up of adult male monozygotic twins.Spine(Phila Pa 1976).2008;33(13):1484-1490.
[22]Cheng X,Zhang K,Sun X,et al.Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis.Spine J.2017;17(8):1127-1133.
[23]李显博,常恒瑞,王立飞,等.单纯减压与减压融合内固定治疗退变性腰椎滑脱的荟萃分析[J].中国矫形外科杂志,2018,26(17):1585-1591.
[24]Blumenthal C,Curran J,Benzel EC,et al.Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis.J Neurosurg Spine.2013;18(4):340-346.
[25]Ghogawala Z,Dziura J,Butler WE,et al.Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis.New Eng J Med.2016;374(15):1424-1434.
[26]Mummaneni PV,Bisson EF,Kerezoudis P,et al.Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis:analysis of the Quality Outcomes Database.Neurosurg Focus.2017;43(2):E11.
[2]王立侠,李龙鹏,李涛,等.腰椎滑脱的X线诊断价值[J].中国医药导刊,2015,17(9):918-919.
[3]沈剑粦,王宸.退行性腰椎不稳诊断的研究进展[J].东南大学学报(医学版),2013,32(1):118-121.
[4]Hipp JA,Guyer RD,Zigler JE,et al.Development of a novel radiographic measure of lumbar instability and validation using the facet fluid sign.Int J Spine Surg.2015;9:37.
[5]Chaput C,Padon D,Rush J,et al.The significance of increased fluid signal on magnetic resonance imaging in lumbar facets in relationship to degenerative spondylolisthesis.Spine(Phila Pa 1976).2007;32(17):1883-1887.
[6]任东风,侯树勋,吴文闻,等.MRI腰椎小关节积液影像对退行性腰椎动态不稳的预测价值[J].中国疼痛医学杂志,2011,17(3):131-133.
[7]Steiger F,Becker HJ,Standaert CJ,et al.Surgery in lumbar degenerative spondylolisthesis:indications,outcomes and complications.A systematic review.Eur Spine J.2014;23(5):945-973.
[8]Grogan J,Nowicki BH,Schmidt TA,et al.Lumbar facet joint tropism does not accelerate degeneration of the facet joints.AJNR Am J Neuroradiol.1997;18(7):1325-1329.
[9]Griffith JF,Wang YX,Antonio GE,et al.Modified Pfirrmann grading system for lumbar intervertebral disc degeneration.Spine(Phila Pa 1976).2007;32(24):E708-E712.
[10]Boden SD,Wiesel SW.Lumbosacral segmental motion in normal individuals.Have we been measuring instability properly?Spine(Phila Pa 1976).1990;15(6):571-576.
[11]Denis F.The three column spine and its significance in the classification of acute thoracolumbar spinal injuries.Spine(Phila Pa 1976).1983;8(8):817-831.
[12]Alqarni AM,Schneiders AG,Hendrick PA.Clinical tests to diagnose lumbar segmental instability:a systematic review.JOrthop Sports Phys Ther.2011;41(3):130-140.
[13]Rihn JA,Lee JY,Khan M,et al.Does lumbar facet fluid detected on magnetic resonance imaging correlate with radiographic instability in patients with degenerative lumbar disease?Spine(Phila Pa 1976).2007;32(14):1555-1560.
[14]Cho BY,Murovic JA,Park J.Imaging correlation of the degree of degenerative L4-5 spondylolisthesis with the corresponding amount of facet fluid.J Neurosurg Spine.2009;11(5):614-619.
[15]刘大海,刘爽,牟建辉,等.仰卧位MRI测量小关节积液对腰椎退变性滑脱稳定性诊断意义的研究[J].中国实验诊断学,2015,19(9):1564-1565.
[16]Lattig F,Fekete TF,Kleinstuck FS,et al.Lumbar facet joint effusion on MRI as a sign of unstable degenerative spondylolisthesis:should it influence the treatment decision?J Spinal Disord Tech.2015;8(3):95-100.
[17]Fujii W,Kawahito Y,Nagahara H,et al.Monocarboxylate transporter 4,associated with the acidification of synovial fluid,is a novel therapeutic target for inflammatory arthritis.Arthritis Rheumatol.2015;67(11):2888-2896.
[18]Sellam J,Berenbaum F.The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis.Nat Rev Rheumatol.2010;6(11):625-635.
[19]Kirkaldy-Willis WH,Farfan HF.Instability of the lumbar spine.Clin Orthop Relat Res 1982;165:110-123.
[20]Vanhoenacker FM,Eyselbergs M,Cotten A."Spinal degeneration:beyond degenerative disc disease":how to discriminate degeneration from spondylarthropathies?Neuroradiology.2011;53 Suppl 1:S175-S179.
[21]Videman T,Battie MC,Parent E,et al.Progression and determinants of quantitative magnetic resonance imaging measures of lumbar disc degeneration:a five-year follow-up of adult male monozygotic twins.Spine(Phila Pa 1976).2008;33(13):1484-1490.
[22]Cheng X,Zhang K,Sun X,et al.Clinical and radiographic outcomes of bilateral decompression via a unilateral approach with transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis with stenosis.Spine J.2017;17(8):1127-1133.
[23]李显博,常恒瑞,王立飞,等.单纯减压与减压融合内固定治疗退变性腰椎滑脱的荟萃分析[J].中国矫形外科杂志,2018,26(17):1585-1591.
[24]Blumenthal C,Curran J,Benzel EC,et al.Radiographic predictors of delayed instability following decompression without fusion for degenerative grade I lumbar spondylolisthesis.J Neurosurg Spine.2013;18(4):340-346.
[25]Ghogawala Z,Dziura J,Butler WE,et al.Laminectomy plus fusion versus laminectomy alone for lumbar spondylolisthesis.New Eng J Med.2016;374(15):1424-1434.
[26]Mummaneni PV,Bisson EF,Kerezoudis P,et al.Minimally invasive versus open fusion for Grade I degenerative lumbar spondylolisthesis:analysis of the Quality Outcomes Database.Neurosurg Focus.2017;43(2):E11.