Department of Medicine, Dartmouth Medical School, Lebanon, NH 03756, USA.
Spine (Phila Pa 1976). 2013 Jun 15;38(14):1216-25. doi: 10.1097/BRS.0b013e31828ce66d.
A retrospective cohort design.
To determine whether baseline magnetic resonance imaging findings, including central/foraminal stenosis, Modic change, disc morphology, facet arthropathy, disc degeneration, nerve root impingement, and thecal sac compression, are associated with differential surgical treatment effect.
Intervertebral disc herniation remains the most common source of lumbar radiculopathy treated either with discectomy or nonoperative intervention. Although magnetic resonance imaging remains the reliable "gold standard" for diagnosis, uncertainty surrounds the relationship between magnetic resonance imaging findings and treatment outcomes.
Three hundred seven "complete" images from patients enrolled in a previous trial were de-identified and evaluated by 1 of 4 independent readers. Findings were compared with outcome measures including the Oswestry Disability Index. Differences in surgery and nonoperative treatment outcomes were evaluated between image characteristic subgroups and TE determined by the difference in Oswestry Disability Index scores.
The cohort comprised 40% females with an average age of 41.5 (±11.6) years, 61% of whom underwent discectomy for intervertebral disc herniation. Patients undergoing surgery with Modic type I endplate changes had worse outcomes (-26.4 vs. -39.7 for none and -39.2 for type 2, P = 0.002) and smaller treatment effect (-3.5 vs. -19.3 for none and -15.7 for type 2, P = 0.003). Those with compression of ≥1/3 showed the greatest improvement within the surgical group (-41.9 for ≥1/3 vs. -31.6 for none and -38.1 for <1/3, P = 0.007) and the highest TE (-23 compared with -11.7 for none and -15.2 for <1/3, P = 0.015). Furthermore, patients with minimal nerve root impingement demonstrated worse surgical outcomes (-26.5 vs. -41.1 for "displaced" and -38.9 for "compressed," P = 0.016).
Among patients with intervertebral disc herniation, those with thecal sac compression of 1/3 or more had greater surgical treatment effect than those with small disc herniations and Modic type I changes. In addition, patients with nerve root "compression" and "displacement" benefit more from surgery than those with minimal nerve root impingement.
回顾性队列设计。
确定基线磁共振成像（MRI）表现，包括中央/椎间孔狭窄、Modic 改变、椎间盘形态、小关节病、椎间盘退变、神经根受压和硬脊膜囊受压，是否与不同的手术治疗效果相关。
椎间盘突出症仍然是治疗腰椎神经根病最常见的原因，可采用椎间盘切除术或非手术治疗。尽管 MRI 仍然是可靠的“金标准”诊断方法，但 MRI 表现与治疗结果之间的关系尚不确定。
从先前试验中招募的 307 名“完整”患者的图像被去识别，并由 4 名独立读者中的 1 名进行评估。研究结果与包括 Oswestry 残疾指数在内的疗效评估指标进行比较。通过 Oswestry 残疾指数评分的差异，评估图像特征亚组与手术和非手术治疗效果之间的差异，并确定治疗效果差异（TE）。
该队列包括 40%的女性，平均年龄为 41.5（±11.6）岁，61%的患者因椎间盘突出症接受了椎间盘切除术。接受 Modic Ⅰ型终板改变手术治疗的患者预后较差（无 Modic 改变的患者为-26.4，Modic Ⅱ型为-39.7，Modic Ⅰ型为-39.2，P=0.002），且治疗效果差异更小（无 Modic 改变的患者为-3.5，Modic Ⅱ型为-19.3，Modic Ⅰ型为-15.7，P=0.003）。受压程度≥1/3 的患者在手术组中改善最大（受压程度≥1/3 的患者为-41.9，无受压的患者为-31.6，受压程度<1/3 的患者为-38.1，P=0.007），且 TE 最高（与无受压的患者相比为-23，与受压程度<1/3 的患者相比为-11.7，P=0.015）。此外，神经根受压程度最小的患者手术预后较差（“移位”的患者为-26.5，“受压”的患者为-41.1，P=0.016）。
在椎间盘突出症患者中，硬脊膜囊受压程度为 1/3 或以上的患者手术治疗效果优于小椎间盘突出症和 Modic Ⅰ型改变的患者。此外，神经根“受压”和“移位”的患者比神经根受压程度最小的患者从手术中获益更多。
2 级。
