Albert Hanne B, Manniche Claus
The Back Research Center, Part of Clinical Locomotion Science, University of Southern Denmark, Lindevej 5, 5750 Ringe, Denmark.
Eur Spine J. 2007 Jul;16(7):977-82. doi: 10.1007/s00586-007-0336-8. Epub 2007 Mar 3.
Only a small proportion (20%) of patients with LBP can be diagnosed based on a patho-anatomical entity. Therefore, the identification of relevant subgroups, preferably on a patoanatomical basis, is strongly needed. Modic changes have been described by several authors as being closely linked with LBP. The aims of this study were to describe the prevalence of Modic changes, their development as well as their association to LBP, previous disc contour, and surgery in patients with previous severe sciatica. This is a longitudinal cohort study where the patients were recruited from an RCT comparing two active conservative treatments, the 181 patients, who at baseline had radicular pain in or below the knee; all underwent a physical examination and MRI. MRI's, pain history and physical examination of 166 patients were obtained at follow-up 14 months later. The prevalence of Modic changes type 1 increased from 9% at baseline to 29% at follow-up. At that time, a strong association between Modic changes and non-specific LBP was noted. Apparently, Modic changes type 1 was more strongly associated with non-specific lumbar pain than Modic changes type 2. The development of new Modic changes was closely related to the level of a previous disc herniation. A lumbar disc herniation is a strong risk factor for developing Modic changes (especially type 1) during the following year. Furthermore, Modic changes are strongly associated with LBP.
仅有一小部分(20%)的腰痛患者能够基于病理解剖实体进行诊断。因此,迫切需要识别相关亚组,最好是基于病理解剖学基础。几位作者已描述Modic改变与腰痛密切相关。本研究的目的是描述Modic改变的患病率、其发展情况以及它们与既往严重坐骨神经痛患者的腰痛、既往椎间盘轮廓和手术的关联。这是一项纵向队列研究,患者从一项比较两种积极保守治疗的随机对照试验中招募,181例患者在基线时膝部或膝部以下有神经根性疼痛;所有患者均接受了体格检查和磁共振成像(MRI)检查。14个月后的随访中获取了166例患者的MRI、疼痛病史和体格检查结果。1型Modic改变的患病率从基线时的9%增加到随访时的29%。当时,注意到Modic改变与非特异性腰痛之间存在强关联。显然,1型Modic改变比2型Modic改变与非特异性腰痛的关联更强。新的Modic改变的发生与既往椎间盘突出的节段密切相关。腰椎间盘突出是次年发生Modic改变(尤其是1型)的一个强风险因素。此外,Modic改变与腰痛密切相关。