The intervertebral disc, the endplates and the vertebral bone marrow as a unit in the process of degeneration
The intervertebral disc, the endplates and the vertebral bone marrow as a unit in the process of degeneration
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DOI：
10.1007/s00330-016-4584-z
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发表时间：
2017-06-01
影响因子：
5.9
通讯作者：
Farshad, Mazda
中科院分区：
文献类型：
--
作者：
Farshad-Amacker, Nadja A.;Hughes, Alexander;Farshad, Mazda
椎间盘退变（DD）和椎体终板退变（EPD）之间的关系尚不清楚。本研究旨在寻找DD和EPD的节段性预测风险因素，并阐明退行性变过程中椎间盘、终板和骨髓变化的相关性。在机构审查委员会批准后，对450个腰椎节段进行了MRI随访至少4年，根据Pfirrmann（PFG）对DD进行回顾性分级，根据终板评分（EPS）和Modic改变（MC）的存在、范围和类型确定EPD。在巢式、配对病例对照亚组中应用非条件Logistic回归和多因素分析来评估潜在的局部进展危险因素，EPS评分为4被确定为DD（OR = 2.32，95%CI：1.07- 5.01，p = 0.03）和MC（OR = 5.49，95%CI：2.30- 13.10，p < 0.001）进展的独立危险因素。DD的进展显著伴随MC的进展或演变（OR = 12.25，95%CI：1.49- 100.6，p = 0.02）和EPS的进展（OR = 1.71，95%CI：1.00-1.05，p = 0.01）。一旦发生晚期椎间盘退变，则成为EPS进展的危险因素（OR = 2.24，95%CI：1.23- 4.12，p < 0.01），椎间盘、终板和骨髓的退变过程高度相关。在腰背痛人群中，EPS a 4是DD和MC进展的独立危险因素。a Euro cent椎间盘、终板和骨髓中的退行性过程是相关的。a Euro cent终板评分a 4是DD和MC进展的危险因素。a Euro cent Modic变化是节段性椎间退变发展中最后发生的。a Euro cent建议了一种新的节段性分级系统。
The association of disc degeneration (DD) and vertebral endplate degeneration (EPD) is still not well understood. This study aimed to find segmental predictive risk factors for DD and EPD and to illuminate associations of the disc, endplate and bone marrow changes in the process of degeneration.After institutional review board approval, 450 lumbar levels, followed up with MRI for at least 4 years, were retrospectively graded for DD according to Pfirrmann (PFG), for EPD according to the endplate score (EPS) and according to the presence, extension and type of Modic changes (MC). Clustered logistic regression and multivariate analysis was applied in nested, matched case-control subgroups to evaluate potential local risk factors for progression.An EPS score of a 4 was identified as an independent risk factor for progression of DD (OR = 2.32, 95%CI:1.07-5.01,p = 0.03) and MC (OR = 5.49,95%CI:2.30-13.10,p < 0.001). Progression of DD was significantly accompanied by progression or evolution of MC (OR = 12.25,95%CI:1.49-100.6,p = 0.02) and with progression of EPS (OR = 1.71, 95%CI:1.00-1.05, p = 0.01). Once advanced DD has occurred, it becomes a risk factor for progression in EPS (OR = 2.24,95%CI:1.23-4.12,p < 0.01).The degenerative processes in the disc, endplate and bone marrow are highly associated. An EPS a 4 is an independent risk factor for DD and MC progression in a population with low back pain.aEuro cent The degenerative processes in the disc, endplate and bone marrow are associated.aEuro cent An endplate score a 4 is a risk factor for DD and MC progression.aEuro cent Modic changes are last to occur in the development of segmental intervertebral degeneration.aEuro cent A new segmental grading system is suggested.