Department of Radiology and Neurosciences Research Center, Imam Reza Medical Center, Tabriz University of Medical Sciences, Golgasht St, Azadi Ave, Tabriz, Iran.
Spine J. 2013 Apr;13(4):402-7. doi: 10.1016/j.spinee.2012.11.047. Epub 2013 Jan 11.
It is suggested that the shape of the vertebral end plates may play a role in the development of abnormalities in the intervertebral disc. On midsagittal magnetic resonance images of the spine in patients with lumbar intervertebral disc herniation, a notable disproportion frequently exists between the end plates of two vertebrae to which the disc is attached. There is apparently no study in the literature examining possible association of this disproportion with development of disc herniation.
To determine whether a disproportion between two neighboring vertebral end plates is associated with the presence of disc herniation at the same level.
Case-control study.
Two hundred fifty patients with primary lumbar disc herniation in the case group and 250 age- and sex-matched normal individuals in the control group.
On midsagittal sections, the difference of anteroposterior diameter of upper and lower end plates neighboring a herniated (in the case group) or normal (in the control group) intervertebral disc was calculated and expressed as "difference of end plates" or "DEP."
Subjects with previous spinal surgery, spondylolisthesis, or a significant vertebral deformity were excluded. For the main outcome variable, DEP was calculated at the level with herniated intervertebral disc in the case group, and the mean value was compared with mean DEP at the same level in the controls.
Mean DEP was significantly higher in the case group at both L4-L5 (2.45±0.28 vs. 2.08±0.27 mm, p=.02) and L5-S1 (3.32±0.18 vs. 2.51±0.13 mm, p<.001) levels. Similar differences were only marginally insignificant at L2-L3 (1.96±0.14 mm in the cases vs. 1.33±0.15 mm in the controls, p=.07) and L3-L4 (2.17±0.11 mm in the cases vs. 1.55±0.09 mm in the controls, p=.06) levels, with no significant difference at L1-L2 level (1.81±0.10 mm in the cases vs. 1.28±0.09 mm in the controls, p=.12). Each 1 mm increase of DEP at L4-L5 and L5-S1 levels was associated with 53% and 56% elevation in disc herniation risk at the corresponding levels, respectively.
Difference of end plate is a significant and probably independent risk factor for lumbar disc herniation.
据认为，椎体终板的形状可能在椎间盘异常的发展中起作用。在腰椎间盘突出症患者的脊柱正中矢状位磁共振图像上，附着椎间盘的两个椎体的终板之间经常存在明显的不成比例。显然，文献中没有研究检查这种不成比例与椎间盘突出症的发展之间的可能关联。
确定两个相邻椎体终板之间的不成比例是否与同一水平的椎间盘突出症的存在有关。
病例对照研究。
250 例原发性腰椎间盘突出症患者为病例组，250 名年龄和性别匹配的正常个体为对照组。
在正中矢状位切片上，计算相邻突出（病例组）或正常（对照组）椎间盘的上下终板的前后直径差异，并表示为“终板差异”或“DEP”。
排除有脊柱手术史、脊椎滑脱或明显椎体畸形的患者。对于主要结局变量，在病例组中计算有椎间盘突出的水平的 DEP，并将平均值与对照组中同一水平的平均 DEP 进行比较。
L4-L5 水平（2.45±0.28 比 2.08±0.27mm，p=.02）和 L5-S1 水平（3.32±0.18 比 2.51±0.13mm，p<.001）的病例组的平均 DEP 明显更高。在 L2-L3 水平（病例组为 1.96±0.14mm，对照组为 1.33±0.15mm，p=.07）和 L3-L4 水平（病例组为 2.17±0.11mm，对照组为 1.55±0.09mm，p=.06），差异仅略有统计学意义，但在 L1-L2 水平无显著差异（病例组为 1.81±0.10mm，对照组为 1.28±0.09mm，p=.12）。L4-L5 和 L5-S1 水平的 DEP 每增加 1mm，相应水平的椎间盘突出症风险分别升高 53%和 56%。
终板差异是腰椎间盘突出症的一个显著且可能独立的危险因素。
