Vertebral Endplate Defect as Initiating Factor in Intervertebral Disc Degeneration: Strong Association Between Endplate Defect and Disc Degeneration in the General Population.
Vertebral Endplate Defect as Initiating Factor in Intervertebral Disc Degeneration: Strong Association Between Endplate Defect and Disc Degeneration in the General Population.
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DOI：
10.1097/brs.0000000000002352
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发表时间：
2018-03-15
期刊：
影响因子：
3
通讯作者：
Williams FMK
中科院分区：
文献类型：
--
作者：
Rade M;Määttä JH;Freidin MB;Airaksinen O;Karppinen J;Williams FMK
对以女性为主的人群中脊柱磁共振的横断面研究。目的探讨普通人群中椎体终板缺陷与腰椎间盘退变的关系。对导致DD发展的机制缺乏准确的了解。在退化的盘中，机械和结构变化导致盘完整性进一步恶化。椎体终板缺陷在腰椎发育迟缓的发病机制中可能起着重要作用，越来越受到人们的重视。研究人群包括来自TwinsUK的831名双胞胎志愿者(平均年龄54±8岁，95.8%女性)。将8310个终板的T2加权磁共振图像编码为6个等级的终板缺陷。总终极板评分(TEP评分)是通过将同一椎板水平的两个终板缺陷等级相加得到的。使用两种不同的分类对DD进行评估：Pfirmann分级，以及基于4分分级系统的DD的数量性状。用多变量回归分析确定感兴趣的特征与DD的已知危险因素、年龄和体重指数(BMI)之间的关系。建立TEP评分预测DD的受试者操作曲线，并进行生存分析和COX比例风险模型分析。在统计学上，DD与年龄和BMI之间存在显著的相关性。当TEP评分作为多变量模型中的预测因子时，这些关联就失去了意义。在每个腰椎间盘水平，TEP评分都与腰椎退变密切相关(Pfimannp≤0.001；4分分级系统p<；1e-16)。TEP评分的分界点为5分，高于5分者有较高的DD患病率。在所有年龄组中，那些被认为TEP评分阳性的人患上DD的概率显著增加(≥5)。我们以人群为基础的大型研究表明，终板缺陷与每个腰椎间盘节段的腰椎退行性变有强烈和独立的关联。这些结果提供了一种增龄和BMI易患DD的机制。
Cross-sectional study of spine MR in a population, predominantly female, sample. To determine the relationship between vertebral endplate defect and intervertebral disc degeneration (DD) in general population. Precise understanding of the mechanisms leading to DD development is lacking. In a degenerating disc, mechanical and structural changes lead to further worsening of disc integrity. Increasing attention has been paid to vertebral endplate defects as having a possible role in the etiopathogenesis of DD. The study population comprised 831 twin volunteers from TwinsUK (mean age 54±8 years, 95.8% female). Lumbar T2-weighted magnetic resonance images were coded for endplate defects from 8310 endplates into six grades. Total endplate score (TEP score) was achieved by summing both endplate defect grades from the same disc level. DD was evaluated using two different classifications; Pfirrmann grading, and a quantitative trait for DD based on a 4-point grading systems. Multivariable regression analysis was used to determine relationships between the traits of interest and the known risk factors for DD, age and body mass index (BMI). A receiver operator curve for TEP score predicting DD was generated, and survival analysis paired with Cox proportional hazards models analysis performed. There was statistically significant association between DD and age and BMI. These associations lost significance when TEP score was included as predictor in multivariable model. TEP score was strongly and independently associated at every lumbar disc level with DD (Pfirmann p≤0.001; 4-point grading systems p<1e-16). A cut-off point score of 5 for TEP score was found above which there was a higher DD prevalence. Across all age subgroups, probabilities of having DD were significantly increased in those considered TEP score positive (≥5). Our large, population-based study has shown that endplate defect was strongly and independently associated with DD at every lumbar disc level. These results provide a mechanism by which increasing age and BMI predispose to DD.