METHODS: A total of 268 consecutive patients diagnosed as L5/S1 low-grade IS between May 2017 and May 2022 were retrospectively enrolled in this study. Depending on the presence of L4/5 disc herniation or not, patients were divided into an L4/5 disc herniation group (L4/5 DH) and an L4/5 non-disc herniation group (L4/5 non-DH). Radiographic parameters were measured, and the ratios of L4-S1 segmental lordosis (SL) to lumbar lordosis (LDI), L4 inferior endplate (IEP) to L5 superior endplate (SEP) (L4 IEP/L5 SEP), and L5 IEP to S1 SEP (L5 IEP/S1 SEP) were compared between groups. The Pfirrmann grade of the L4/5 disc and the L5/S1 disc, and Roussouly classifications of each patient were also recorded. Univariate analysis (including independent-samples t-test and χ2 -test) and multiple logistic regression analysis were performed to analyze the data.
RESULTS: There were 40 patients (14.9%) in the L4/5 DH group. The Roussouly classification differed significantly between groups. As demonstrated by the Pfirrmann grade, the L4/5 DH group showed more advanced disc degeneration at L4/5 than the L4/5 non-DH group. In contrast to the L4/5 non-DH group, the L4/5 DH group had a significantly larger L4 IEP, L4 IEP/L5 SEP, S1 SEP, and LDI while smaller L4/5 disc angle, L4/5 disc height, slip percentage, lumbar lordosis, and sacral slope. Multivariate logistic regression analysis revealed that higher L4/5 disc Pfirrmann grade (p = 0.004), decreased L4/5 disc height (p < 0.001), and lower L5 slip percentage (p = 0.022) were significantly associated with the occurrence of L4/5 DH.
CONCLUSIONS: L4/5 disc herniation is not unusually accompanied by L5/S1 low-grade IS. Advanced L4/5 disc degeneration, decreased L4/5 disc height, and lower L5 slip percentage might be significantly associated with L4/5 disc herniation.
方法:对2017年5月至2022年5月期间诊断为L5/S1低度IS的268例连续患者进行回顾性研究。取决于L4/5椎间盘突出的存在与否,患者分为L4/5椎间盘突出组(L4/5DH)和L4/5非椎间盘突出组(L4/5非DH).测量射线照相参数,L4-S1节段前凸(SL)与腰椎前凸(LDI)的比值,L4下端板(IEP)至L5上端板(SEP)(L4IEP/L5SEP),组间比较L5IEP至S1SEP(L5IEP/S1SEP)。L4/5光盘和L5/S1光盘的Pfirrmann等级,并记录每位患者的Roussouly分类。采用单因素分析(包括独立样本t检验和χ2检验)和多因素logistic回归分析。
结果:L4/5DH组40例(14.9%)。Roussouly分类在组间有显著差异。正如Pfirrmann等级所证明的那样,与L4/5非DH组相比,L4/5DH组的椎间盘退变程度更高.与L4/5非DH组相比,L4/5DH组的L4IEP明显更大,L4IEP/L5SEP,S1SEP,和LDI,而更小的L4/5盘角度,L4/5盘高度,滑移百分比,腰椎前凸,和骶骨斜坡。多因素logistic回归分析显示L4/5椎间盘Pfirrmann分级较高(p=0.004),L4/5椎间盘高度降低(p<0.001),较低的L5滑移百分比(p=0.022)与L4/5DH的发生显着相关。
结论:L4/5椎间盘突出症并不罕见地伴有L5/S1低度IS。晚期L4/5椎间盘退变,L4/5盘高度降低,较低的L5滑脱率可能与L4/5椎间盘突出显著相关。