Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.
Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.
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DOI：
10.3174/ajnr.a4173
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发表时间：
2015-04
期刊：
影响因子：
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通讯作者：
Jarvik JG
中科院分区：
文献类型：
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作者：
Brinjikji W;Luetmer PH;Comstock B;Bresnahan BW;Chen LE;Deyo RA;Halabi S;Turner JA;Avins AL;James K;Wald JT;Kallmes DF;Jarvik JG
退行性变化通常在脊柱成像中发现，但通常发生在无痛患者和背痛患者中。我们试图通过对无症状个体影像学上脊柱退变的患病率进行系统回顾，来估计常见退行性脊柱疾病的患病率（按年龄）。我们对截至2014年4月发表的英文文献中报告无症状个体的影像学检查结果（CT或MR成像）患病率的文章进行了系统性综述。两名审稿人对每份手稿进行了评估。我们按年龄段（20岁、30岁、40岁、50岁、60岁、70岁、80岁）选择年龄组，确定特定年龄的患病率估计值。对于每一个影像学发现，我们拟合一个广义线性混合效应模型，用于研究中年龄特异性患病率估计聚类，并根据报告年龄间隔的中点进行调整。33篇文章报告了3110例无症状个体的影像学表现，符合我们的研究纳入标准。椎间盘退变在无症状个体中的患病率从20岁个体的37%增加到80岁个体的96%。椎间盘突出的患病率从20岁的30%增加到80岁的84%。椎间盘突出的患病率从20岁的29%增加到80岁的43%。环裂患病率从20岁组的19%上升到80岁组的29%。脊柱退变的影像学表现存在于高比例的无症状个体中，随着年龄的增长而增加。许多基于成像的退行性特征可能是正常衰老的一部分，与疼痛无关。这些影像学检查结果必须结合患者的临床状况进行解释。
Degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. We sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals. We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014. Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates. For each imaging finding, we fit a generalized linear mixed-effects model for the age-specific prevalence estimate clustering in the study, adjusting for the midpoint of the reported age interval. Thirty-three articles reporting imaging findings for 3110 asymptomatic individuals met our study inclusion criteria. The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age. Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient’s clinical condition.