Abstract：
BACKGROUND: Researchers have recently linked hysterectomy, which alters sex hormone levels, to diseases like osteoporosis, lumbar spondylolisthesis, hypertension and diabetes etc. However, the association between hysterectomy and lumbar disc herniation (LDH)/lumbar spinal stenosis (LSS) remains unclarified.
OBJECTIVE: To determine whether there is a correlation between hysterectomy and surgical intervention for LDH/LSS in women, further substantiated through imaging and clinical research.
METHODS: A case control and cohort study.
METHODS: The study group comprised 1202 female patients aged 45 and older who had undergone operative treatment due to LDH/LSS (825 for LDH and 377 for LSS), and the comparison group comprised 1168 females without lumbar diseases who visited health examination clinic during the same period. One hundred and 2 hysterectomized patients were further selected (Hysterectomy cohort) and matched approximately with the control cohort at a 1:2 ratio from the study group with a minimum follow-up of 2 years.
METHODS: Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated to assess the association between hysterectomy and surgical intervention for LDH/LSS in women after adjusted by confounding factors. Patients from both the hysterectomy and control cohorts underwent a comprehensive assessment. This assessment included the evaluation of several parameters: the functional cross-sectional area, fat infiltration rate, relative functional cross-sectional area of the lumbar paravertebral muscles, facet joint degeneration grade, cartilage endplate damage, Modic changes for the L3/4-L5/S1 segments, Pfirrmann grade of lumbar disc degeneration, and disc height index for the L1/2-L5/S1 segments. Additionally, the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores were recorded preoperatively and at the last follow-up.
METHODS: Associations between hysterectomy and patients treated surgically for LDH or LSS were analyzed using multivariate binomial logistic regression analysis. Lumbar X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were used to evaluate the imaging variables. Imaging and clinical variables were compared.
RESULTS: Hysterectomized women were associated with requiring surgery due to LDH/LSS, with ORs of 2.613 (p<.001) and 2.084 (p=.006), respectively. The imaging evaluation further revealed that the hysterectomy cohort had more severe degeneration of the paraspinal muscles, facet joints, endplates, and intervertebral discs, Modic changes at L3/4-L5/S1 segments, and intervertebral height reduction at L1/2-L5/S1 segments when compared to the control cohort (p<.01). Compared to the control cohort, the hysterectomy cohort exhibited higher preoperative and last follow-up VAS scores for low back pain, and last follow-up JOA scores (p<.01).
CONCLUSIONS: Based on the findings of this study, it seems that women who have had a hysterectomy are correlated with requiring surgical intervention due to LDH/LSS. Imaging and clinical studies also indicate that hysterectomized patients exhibited more severe lumbar degeneration and back pain.
OBJECTIVE: To determine whether there is a correlation between hysterectomy and surgical intervention for LDH/LSS in women, further substantiated through imaging and clinical research.
METHODS: A case control and cohort study.
METHODS: The study group comprised 1202 female patients aged 45 and older who had undergone operative treatment due to LDH/LSS (825 for LDH and 377 for LSS), and the comparison group comprised 1168 females without lumbar diseases who visited health examination clinic during the same period. One hundred and 2 hysterectomized patients were further selected (Hysterectomy cohort) and matched approximately with the control cohort at a 1:2 ratio from the study group with a minimum follow-up of 2 years.
METHODS: Odds Ratios (ORs) and 95% Confidence Intervals (CIs) were calculated to assess the association between hysterectomy and surgical intervention for LDH/LSS in women after adjusted by confounding factors. Patients from both the hysterectomy and control cohorts underwent a comprehensive assessment. This assessment included the evaluation of several parameters: the functional cross-sectional area, fat infiltration rate, relative functional cross-sectional area of the lumbar paravertebral muscles, facet joint degeneration grade, cartilage endplate damage, Modic changes for the L3/4-L5/S1 segments, Pfirrmann grade of lumbar disc degeneration, and disc height index for the L1/2-L5/S1 segments. Additionally, the Visual Analog Scale (VAS) and Japanese Orthopaedic Association (JOA) scores were recorded preoperatively and at the last follow-up.
METHODS: Associations between hysterectomy and patients treated surgically for LDH or LSS were analyzed using multivariate binomial logistic regression analysis. Lumbar X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) were used to evaluate the imaging variables. Imaging and clinical variables were compared.
RESULTS: Hysterectomized women were associated with requiring surgery due to LDH/LSS, with ORs of 2.613 (p<.001) and 2.084 (p=.006), respectively. The imaging evaluation further revealed that the hysterectomy cohort had more severe degeneration of the paraspinal muscles, facet joints, endplates, and intervertebral discs, Modic changes at L3/4-L5/S1 segments, and intervertebral height reduction at L1/2-L5/S1 segments when compared to the control cohort (p<.01). Compared to the control cohort, the hysterectomy cohort exhibited higher preoperative and last follow-up VAS scores for low back pain, and last follow-up JOA scores (p<.01).
CONCLUSIONS: Based on the findings of this study, it seems that women who have had a hysterectomy are correlated with requiring surgical intervention due to LDH/LSS. Imaging and clinical studies also indicate that hysterectomized patients exhibited more severe lumbar degeneration and back pain.
摘要：
背景：研究人员最近将子宫切除术联系起来，改变性激素水平，像骨质疏松症这样的疾病，腰椎滑脱,高血压和糖尿病等.然而,子宫切除术与腰椎间盘突出症(LDH)/腰椎管狭窄症(LSS)之间的关联尚不清楚.
目的：为了确定子宫切除术与女性LDH/LSS的手术干预之间是否存在相关性，通过影像学和临床研究进一步证实。
方法：病例对照和队列研究。
方法：研究组包括1202名45岁及以上因LDH/LSS而接受手术治疗的女性患者（LDH为825名，LSS为377名）。对照组为同期就诊于健康体检诊所的1168名无腰椎疾病的女性。进一步选择了一百零二位子宫切除患者（子宫切除术队列），并以1：2的比例与对照组大致匹配，最少随访2年。
方法：计算赔率比（ORs）和95%置信区间（CIs），以评估子宫切除术与女性LDH/LSS手术干预之间的相关性。对子宫切除术和对照组的患者进行了全面评估。该评估包括对几个参数的评估：功能横截面积，脂肪浸润率,腰椎旁肌肉的相对功能横截面积，小关节退变等级,软骨终板损伤，L3/4-L5/S1段的修改更改，腰椎间盘退变的Pfirrmann分级，和L1/2-L5/S1段的圆盘高度指数。此外,我们在术前和末次随访时记录视觉模拟量表(VAS)和日本骨科协会(JOA)评分.
方法：使用多变量二项logistic回归分析子宫切除术与LDH或LSS手术患者之间的关联。腰椎X光片,计算机断层扫描(CT)和磁共振成像(MRI)用于评估成像变量.比较了影像学和临床变量。
结果：子宫切除的妇女因LDH/LSS而需要手术，ORs为2.613（P<0.001）和2.084（P=0.006），分别。影像学评估进一步显示，子宫切除术队列有更严重的椎旁肌肉变性，面关节,端板,和椎间盘，L3/4-L5/S1段的修改变化，与对照组相比，L1/2-L5/S1节段的椎间高度降低（P<0.01）。与对照组相比，子宫切除术队列对下腰背痛的术前和最后一次随访VAS评分较高，末次随访JOA评分(P<0.01)。
结论：根据本研究的结果，子宫切除术的女性似乎与LDH/LSS需要手术干预相关.影像学和临床研究还表明，子宫切除患者表现出更严重的腰椎退变和背痛。
目的：为了确定子宫切除术与女性LDH/LSS的手术干预之间是否存在相关性，通过影像学和临床研究进一步证实。
方法：病例对照和队列研究。
方法：研究组包括1202名45岁及以上因LDH/LSS而接受手术治疗的女性患者（LDH为825名，LSS为377名）。对照组为同期就诊于健康体检诊所的1168名无腰椎疾病的女性。进一步选择了一百零二位子宫切除患者（子宫切除术队列），并以1：2的比例与对照组大致匹配，最少随访2年。
方法：计算赔率比（ORs）和95%置信区间（CIs），以评估子宫切除术与女性LDH/LSS手术干预之间的相关性。对子宫切除术和对照组的患者进行了全面评估。该评估包括对几个参数的评估：功能横截面积，脂肪浸润率,腰椎旁肌肉的相对功能横截面积，小关节退变等级,软骨终板损伤，L3/4-L5/S1段的修改更改，腰椎间盘退变的Pfirrmann分级，和L1/2-L5/S1段的圆盘高度指数。此外,我们在术前和末次随访时记录视觉模拟量表(VAS)和日本骨科协会(JOA)评分.
方法：使用多变量二项logistic回归分析子宫切除术与LDH或LSS手术患者之间的关联。腰椎X光片,计算机断层扫描(CT)和磁共振成像(MRI)用于评估成像变量.比较了影像学和临床变量。
结果：子宫切除的妇女因LDH/LSS而需要手术，ORs为2.613（P<0.001）和2.084（P=0.006），分别。影像学评估进一步显示，子宫切除术队列有更严重的椎旁肌肉变性，面关节,端板,和椎间盘，L3/4-L5/S1段的修改变化，与对照组相比，L1/2-L5/S1节段的椎间高度降低（P<0.01）。与对照组相比，子宫切除术队列对下腰背痛的术前和最后一次随访VAS评分较高，末次随访JOA评分(P<0.01)。
结论：根据本研究的结果，子宫切除术的女性似乎与LDH/LSS需要手术干预相关.影像学和临床研究还表明，子宫切除患者表现出更严重的腰椎退变和背痛。
