ISSLS Prize Winner: Lumbar Vertebral Endplate Lesions Associations With Disc Degeneration and Back Pain History
ISSLS Prize Winner: Lumbar Vertebral Endplate Lesions Associations With Disc Degeneration and Back Pain History
复制标题
DOI：
10.1097/brs.0b013e3182608ac4
复制
发表时间：
2012-08-01
期刊：
影响因子：
3
通讯作者：
Battie, Michele C.
中科院分区：
文献类型：
--
作者：
Wang, Yue;Videman, Tapio;Battie, Michele C.
研究设计。尸检研究。很客观。目的：研究不同类型的腰椎终板病变、腰椎间盘退行性变(DD)和腰背痛病史之间的关系。神经支配良好的脊椎终板被怀疑是导致背部疼痛的原因。在此之前，我们观察到了4种具有不同形态特征的腰椎终板病变。它们在DD和背部疼痛中的作用尚不清楚。从136名男性(平均年龄52岁)的腰椎档案中，69名受试者的背部疼痛、背部损伤和职业史数据以及109名受试者的443个椎间盘的椎间盘造影术数据可供研究。背痛病史分为无背痛、偶有背痛或频繁背痛。根据椎间隙造影术判断腰椎退行性变。终板病变分为Schmorl结节、骨折、侵蚀或钙化，病变大小分为无、小、中等或大。研究终板损伤与腰椎退行性变、背痛病史、背部损伤和职业史之间的关系。终板病变的存在与频繁(优势比[OR]=2.57)有关，但与偶发性背痛无关。然而，较大的终板病变与偶发性(OR=8.68)和频繁(OR=17.88)背部疼痛有关。在对DD进行进一步控制后，这种关联仍然存在。此外，每种终板病变的存在与邻近的DD相关(OR=2.40-9.71)，更大的病变与更严重的DD相关。与Schmorl‘s结节相比，终板侵蚀病变与邻近DD的相关性更强。虽然背部损伤史与骨折和侵蚀损伤的存在有关，但重度占位与Schmorl‘s结节的存在有关。终板病变与背部疼痛以及与邻近的DD密切相关，具有明显的剂量效应。不同类型的终板病变似乎与DD有不同程度的关联。腰椎终板病变可能是更好地了解DD和背部疼痛的重要关键。
Study Design. An autopsy study.Objective. To investigate associations between various types of lumbar endplate lesions, disc degeneration (DD), and back pain history.Summary of Background Data. The well-innervated vertebral endplate has been suspected as a source of back pain. Previously, we observed 4 types of lumbar endplate lesions with distinct morphological characteristics. Their roles in DD and back pain remain unclear.Methods. From a lumbar spine archive of 136 men (mean age, 52 yr), back pain, back injury, and occupation history data for 69 subjects and discography data for 443 discs from 109 subjects were available for study. Back pain history was categorized as none, occasional, or frequent. DD was judged from discography. Endplate lesions were classified as Schmorl's nodes, fracture, erosion, or calcification, and lesion size was rated as none, small, moderate, or large. Associations between endplate lesions and DD, back pain history, back injury, and occupation history were examined.Results. Presence of endplate lesions was associated with frequent (odds ratio [OR] = 2.57) but not occasional back pain. However, large endplate lesions were associated with both occasional (OR = 8.68) and frequent (OR = 17.88) back pain. This association remained after further controlling for DD. Also, the presence of each type of endplate lesion was associated with adjacent DD (OR = 2.40-9.71), with larger lesions associated with more severe DD. Endplate erosion lesions were more strongly associated with adjacent DD than Schmorl's nodes. Although back injury history was associated with the presence of fracture and erosion lesions, heavy occupation was associated with the presence of Schmorl's nodes.Conclusion. Endplate lesions are associated with back pain as well as being closely associated with adjacent DD, with a clear dosage effect. Different types of endplate lesions seem to have different magnitudes of associations with DD. Lumbar endplate lesions may be an important key to better understand both DD and back pain.