Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present
Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present
复制标题
当存在 Modic 改变时，经皮内镜腰椎间盘切除术后复发性椎间盘突出症优先发生
DOI：
10.1186/s13018-020-01695-6
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发表时间：
2020-05-14
影响因子：
2.6
通讯作者：
Zhao, Fengdong
中科院分区：
文献类型：
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作者：
Hao, Lu;Li, Shengwen;Zhao, Fengdong
目的探讨经皮内镜下腰椎间盘切除术（PELD）后Modic改变（MCs）与复发性腰椎间盘突出症（rLDH）的关系，以及突出的椎间盘成分与rLDH的关系。所有患者术前均行CT和MRI检查。评估Modic变化的存在和类型。术中将每位患者的椎间盘突出物分为两组：髓核组和透明软骨组。研究了椎间盘突出与Modic改变的关系。rLDH的发病率进行了评估的基础上超过2年的follow-up.ResultsIn总数，11例患者失访，其他91人随访期间24-60个月。在91例患者中，99例椎间盘接受了PELD; 28/99例（28.3%）有MC。I型和II型MCs分别为9例（9.1%）和19例（19.2%），未发现III型MCs。在28例MCs终板中，根据突出椎间盘的成分，18/28例（64.3%）术中标本显示透明软骨，其中6/9例和12/19例终板分别为I型和II型MCs。在71个无MC的终板中，14/71（19.7%）在术中标本中显示出透明软骨的证据。透明软骨在MCs中多见（P< 0.05）。在非MC组中发现2例rLDH（n= 71）;在MC组中发现6例rLDH（n= 28），其中I型2例，II型4例。Ⅰ型与Ⅱ型之间无显著性差异（P> 0.05）。rLDH在MCs组中较MCs组多见（P< 0.05）。透明软骨组32例中发现5例rLDH，髓核组67例中发现3例rLDH。结论PELD术后rLDH的发生主要发生在有MC或软骨突出的情况下。
ObjectiveTo investigate the relationship between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH) and that between the herniated disc component and rLDH following percutaneous endoscopic lumbar discectomy (PELD).MethodsWe included 102 (65 males, 37 females, aged 20–66 years) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperatively. The presence and type of Modic changes were assessed. During surgery, the herniated disc component of each patient was classified into two groups: nucleus pulposus group and hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of rLDH was assessed based on a more than 2-year follow-up.ResultsIn total, 11 patients were lost to follow-up; the other 91 were followed up during 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P< 0.05). We found 2 cases of rLDH in the non-MC group (n= 71); 6 cases of rLDH were found in the MC group (n= 28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P> 0.05). rLDH was more common in patients with MCs (P< 0.05). We found 5 rLDH cases in the hyaline cartilage group (n= 32); 3 rLDH cases were found in the nucleus pulposus group (n= 67). rLDH was more common in the hyaline cartilage group (P< 0.05).ConclusionsrLDH following PELD preferentially occurs when MCs or herniated cartilage are present.