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Modic 改变、可能的病因及对腰椎间盘退变的影响。

Modic changes, possible causes and promotion to lumbar intervertebral disc degeneration.

机构信息

Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China.

出版信息

Med Hypotheses. 2009 Dec;73(6):930-2. doi: 10.1016/j.mehy.2009.06.038. Epub 2009 Jul 24.

Abstract

UNLABELLED

Modic changes are bone marrow and endplate lesions visible in magnetic resonance imaging (MRI). They are regarded as a part of degenerative disc disease and associated with low back pain. And severe disc degeneration was occurred more in the patients with Modic changes. But there is still no study to analyze the relationship between Modic changes and intervertebral disc degeneration. We hypothesize that Modic changes are the possible causes and promotion of lumbar intervertebral disc degeneration. And there are three possible mechanisms for this hypothesis: a structural cause: Modic changes make cartilaginous material easier in extruded disc herniations, to destroy the structure of intervertebral disc and inhibit the absorption of the disc. A biomechanical cause: Modic changes alter the mechanical loading distribution on disc, to initiate a series of disc disruption and inhibit the self-recovery of the disc. A nutritional cause: Modic changes destroy the vascular architecture in vertebral endplate and block the most important metabolism pathway between vertebrae and disc.

PERSPECTIVES

(1) Find out procedures to cure Modic changes may be an important breakthrough for disc degenerative disease. (2) Treatment of Modic changes may be a critical step of biotherapy for disc degeneration disease.

摘要

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磁共振成像(MRI)可见骨髓和终板病变,即 Modic 改变。这些改变被认为是椎间盘退行性病变的一部分,并与下腰痛相关。Modic 改变患者的严重椎间盘退变更为常见。但目前仍缺乏分析 Modic 改变与椎间盘退行性变之间关系的研究。我们假设 Modic 改变是腰椎间盘退行性变的可能原因和促进因素。对于这一假说,有三种可能的机制:结构原因:Modic 改变使软骨样物质更容易在椎间盘突出物中突出,破坏椎间盘的结构并抑制椎间盘的吸收。生物力学原因:Modic 改变改变了椎间盘的机械载荷分布,引发一系列椎间盘破坏并抑制椎间盘的自我修复。营养原因:Modic 改变破坏了椎体终板的血管结构,阻断了椎体与椎间盘之间最重要的代谢途径。

观点

(1)找出治疗 Modic 改变的方法可能是治疗椎间盘退行性疾病的重要突破。(2)治疗 Modic 改变可能是椎间盘退行性疾病生物治疗的关键步骤。

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