Abstract:
Adjacent segment degeneration is commonly observed in patients after fusion surgery. Among the associated risk factors is the preoperative presence of adjacent disc degeneration (ADD). The risk factors and other spine phenotypes associated with preoperative ADD is critical to understand the pathological process and better prognosis postsurgery. Current study aims to assess and compare the magnetic resonance imaging (MRI) spinal phenotype of herniated level with and without ADD. Preoperative T2W sagittal lumbar MRI images of 155 lumbar disc herniated patients were analyzed for the presence of ADD (Pfirrmann grade III and above). The herniated disc level was assessed for the presence and absence of vertebral endplate (VEP) defects, Modic changes, and high intensity zone (HIZ). Mean age of patients was 38 ± 2 years, almost 62% were males. ADD was found in 57%, VEP defects were seen in 62% of the herniated level, 24.5% showed Modic changes, 3.8% showed spondylolishthesis, and 15.5% revealed HIZ. Age and other demographic factors did not have any significant effect on the presence of ADD, the patients with extruded and sequestered discs had more ADD (p = 0.02). VEP defects were significantly higher in levels with ADD (p = 0.02). Patients with ADD had significantly VEP defect scores (p = 0.01), Modic score (p = 0.002), HIZ score (0.02), and posterior bulge score (p < 0.001). Findings suggest that affected levels with VEP defects and severe grade of disc herniation have the greater likelihood of having ADD. Once developed this ADD may also affect the other spinal levels, and also can affect postoperative prognosis.
摘要:
在融合手术后的患者中通常观察到相邻节段变性。相关的危险因素是术前存在相邻的椎间盘退变(ADD)。与术前ADD相关的危险因素和其他脊柱表型对于了解病理过程和术后更好的预后至关重要。当前的研究旨在评估和比较有无ADD的突出水平的磁共振成像(MRI)脊柱表型。分析155例腰椎间盘突出症患者的术前T2W矢状位腰椎MRI图像是否存在ADD(PfirrmannIII级及以上)。评估椎间盘突出水平是否存在椎体终板(VEP)缺损,修改更改,和高强度区(HIZ)。患者平均年龄为38±2岁,近62%是男性。57%的人发现了ADD,VEP缺损见于62%的疝层,24.5%显示Modic变化,3.8%显示脊椎滑脱,15.5%的人透露了HIZ。年龄和其他人口统计学因素对ADD的存在没有任何显著影响,椎间盘突出和隔离的患者ADD更多(p=0.02).VEP缺陷在ADD水平上明显更高(p=0.02)。ADD患者有显著的VEP缺损评分(p=0.01),修改分数(p=0.002),HIZ评分(0.02),和后隆起评分(p<0.001)。研究结果表明,患有VEP缺陷和严重椎间盘突出症的受影响水平具有更大的ADD可能性。一旦发展,这种ADD也可能影响其他脊髓水平,也会影响术后预后。