Changes in Lumbar Endplate Area and Concavity Associated With Disc Degeneration.
Changes in Lumbar Endplate Area and Concavity Associated With Disc Degeneration.
复制标题
与椎间盘退变相关的腰椎终板区域和凹度的变化。
DOI：
10.1097/brs.0000000000002657
复制
发表时间：
2018
期刊：
影响因子：
3
通讯作者：
NozomuInoue
中科院分区：
文献类型：
--
作者：
Louie,PhilipK;EspinozaOrías,AlejandroA;Fogg,LouisF;LaBelle,Mark;An,HowardS;Andersson,GunnarBJ;NozomuInoue
研究设计。回顾性基于图像的分析。目的。测量终板三维 (3D) 几何形状、体内终板变化，并研究椎间盘退变和终板 3D 几何形状之间的相关性，取决于腰痛 (LBP) 症状。背景数据摘要。假设从髓核到纤维环的负载传递的改变会影响椎体终板几何形状。方法。下/上的 3D 表面模型腰椎终板是根据 n= 92 名患有或不患有 LBP 的志愿者的计算机断层扫描创建的。使用Pfirrmann量表评估椎间盘退变。使用凹度指数评估冠状面和矢状面的凹度（分别为无单位；大于1：凹；平坦：1；小于1：凸）。计算终板面积和椎间盘高度分布，并通过方差分析模型寻求人口统计学和脊柱退变的影响。结果。与队列中的其他级别相比，矢状面和冠状面均显示，终末级 5 级椎间盘退变患者的凹度显着降低（平均 0.833±0.235）。老年受试者在 L4-S1 处呈现出比年轻受试者更大的终板面积 (P= 0.0148)。总体而言，有症状的受试者的终板面积明显更大（P = 0.022），特别是在较低的腰椎水平（P < 0.001）。方差分析表明，性别、椎间盘水平、椎间盘退变等级和椎间盘高度在两种凹度指数病例中作为影响参数达到显着性（P<0.0001）。结论：随着椎间盘退变的进展，随着时间的推移，终板在矢状面和冠状面都变得更加凸出。我们的研究结果表明，随着椎间盘退变的进展，负荷从髓核转移到纤维环，终板会发生变化，从而导致终板曲率的变化。这也是第一项描述年龄、性别和 LBP 对椎体终板解剖结构的直接影响的研究。证据级别：5 腰痛 (LBP) 仍然是寻求医疗护理时最常见的症状之一，大约 80% 的人在一生中的某个时候经历过 LBP。 1-3 腰椎间盘疾病被描述为持续性坐骨神经痛和腰痛的最常见病因。 4 研究患有或不患有退行性椎间盘疾病的患者的椎间盘生物力学因素对于了解这种病理学以及随后的评估和治疗至关重要。
Study Design.Retrospective image-based analysis.Objective.To measure endplate three-dimensional (3D) geometry, endplate changes in vivo and to investigate correlations between disc degeneration and endplate 3D geometry dependent on symptoms of low back pain (LBP).Summary of Background Data.It has been hypothesized that alteration of load transmission from the nucleus pulposus to the annulus fibrosus affects vertebral endplate geometry.Methods.3D surface models of inferior/superior lumbar endplates were created from computed tomography scans of n= 92 volunteers with and without LBP. Disc degeneration was evaluated using Pfirrmann scale. Concavity in both coronal and sagittal planes was assessed with the Concavity Index (unitless; larger than 1: concave; flat: 1; and less than 1: convex, respectively). Endplate area and disc height distribution were computed and the effects from demographics and spinal degeneration were sought with an analysis of variance model.Results.Both sagittal and coronal planes revealed significantly decreased concavity in those with terminal grade 5 disc degeneration (mean 0.833±0.235) compared to the other grades in the cohort. Older subjects presented with larger endplate areas than the younger subjects (P= 0.0148) at L4-S1. Overall, symptomatic subjects had significantly larger endplate areas (P= 0.022), especially at the lower lumbar levels (P< 0.001). Analysis of variance showed that sex, disc level, disc degeneration grade, and disc height reached significance (P< 0.0001) as influential parameters in both Concavity Index cases.Conclusion.With advancing intervertebral disc degeneration, endplates become more convex over time in both sagittal and coronal planes. Our findings implicate the endplate changes with advancing disc degeneration in the shift in load transmission from the nucleus pulposus to the annulus fibrosus, resulting in changes within the curvature of the endplates. This is also the first study to describe the direct impact of age, sex, and LBP on vertebral endplate anatomy.Level of Evidence: 5Low back pain (LBP) continues to represent one of the most common presentations when seeking medical care, with approximately 80% of the population experiencing LBP sometime during their lifetime. 1–3 Lumbar disc disease has been described as the most common etiology of persistent sciatica and LBP. 4 Investigating biomechanical factors of the intervertebral disc in patients with or without degenerative disc disease is essential in understanding this pathology, and the subsequent evaluation and treatment.