Ma Zheng, Ding Wen-yuan, Shen Yong, Sun Ya-peng, Yang Da-long, Xu Jia-xin
Department of Spinal Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China.
Zhonghua Wai Ke Za Zhi. 2013 Jul;51(7):610-4.
To evaluate the relationship between Modic change and disc height together with lumbar hyperosteogeny and study the role of Modic change in lumbar degeneration.
The imaging data of 150 elderly patients with chronic low back pain were analysed retrospectively. All patients underwent MRI and lumbar lateral X-ray examination. The lumbar disc from L1-L2 to L5-S1 were selected for this study, including 750 discs, vertebral and endplate close to disc in 150 patients. The incidence rate of lumbar endplate Modic change, disc height and the degree of vertebral bone hyperplasia were recorded. The ratio of disc height/lumbar intervertebral disc height < 50% was defined as disc collapse. The patients were divided into 4 groups in the basis of imaging changes. Group A1:disc collapse without severe lumbar hyperosteogeny; Group A2: disc collapse with severe lumbar hyperosteogeny; Group B1: Neither disc collapse nor severe lumbar hyperosteogeny; Group B2: severe lumbar hyperosteogeny without disc collapse. The incidence rates of Modic change were compared between the 4 groups by χ(2) test. Finally, the influence of disc height and vertebral bone hyperplasia on the incidence rate of Modic change was analysed.
Four groups of patients observed a total of 750 discs. The number of intervertebral discs in the group A1 was 208, the incidence rate was 54.3%. The number of intervertebral discs in the group A2 was 135, the incidence rate of group A2 was 34.8%. The number of intervertebral discs in the B1 group was 225, the incidence rate of group B1 was 16.9%. The number of intervertebral discs in the B2 group was 182, the incidence rate of group B2 was 29.7%. There was significant difference of lumbar endplate Modic change incidence rate among the 4 groups(χ(2) = 69.565, P < 0.05). The results of post hoc test showed that the incidence rate of Modic change in group A1 was higher than group A2, B1 and B2 (χ(2) = 12.524, 66.701 and 24.102, P < 0.00714). There was significant difference of Modic change incidence rate between group A2 and B1(χ(2) = 15.032, P < 0.00714), but there was no significant difference of Modic change incidence rate between group A2 and B2 (χ(2) = 0.945, P > 0.00714) . There was significant difference of Modic change incidence rate between group B2 and group B1 (χ(2) = 9.395, P < 0.00714).
The incidence rate of Modic change with disc collapse but without severe lumbar hyperosteogeny is high in elderly patients with chronic low back pain. There is no significant difference of Modic change incidence between patients with both disc collapse and severe lumbar hyperosteogeny and patients with severe lumbar hyperosteogeny but without disc collapse.
评估Modic改变与椎间盘高度以及腰椎骨质增生之间的关系，并研究Modic改变在腰椎退变中的作用。
回顾性分析150例慢性下腰痛老年患者的影像学资料。所有患者均接受了MRI和腰椎侧位X线检查。本研究选取L1-L2至L5-S1节段的腰椎间盘，共750个椎间盘，以及150例患者中靠近椎间盘的椎体和终板。记录腰椎终板Modic改变的发生率、椎间盘高度及椎体骨质增生程度。椎间盘高度/腰椎间盘高度比值<50%定义为椎间盘塌陷。根据影像学改变将患者分为4组。A1组：椎间盘塌陷但无严重腰椎骨质增生；A2组：椎间盘塌陷伴严重腰椎骨质增生；B1组：既无椎间盘塌陷也无严重腰椎骨质增生；B2组：严重腰椎骨质增生但无椎间盘塌陷。采用χ(2)检验比较4组之间Modic改变的发生率。最后，分析椎间盘高度和椎体骨质增生对Modic改变发生率的影响。
4组患者共观察750个椎间盘。A1组椎间盘数量为208个，发生率为54.3%。A2组椎间盘数量为135个，A2组发生率为34.8%。B1组椎间盘数量为225个，B1组发生率为16.9%。B2组椎间盘数量为182个，B2组发生率为29.7%。4组之间腰椎终板Modic改变发生率差异有统计学意义(χ(2)=69.565，P<0.05)。事后检验结果显示，A1组Modic改变发生率高于A2组、B1组和B2组(χ(2)=12.524、66.701和24.102，P<0.00714)。A2组和B1组之间Modic改变发生率差异有统计学意义(χ(2)=15.032，P<0.00714)，但A2组和B2组之间Modic改变发生率差异无统计学意义(χ(2)=0.945，P>0.00714)。B2组和B1组之间Modic改变发生率差异有统计学意义(χ(2)=9.395，P<0.00714)。
慢性下腰痛老年患者中，伴有椎间盘塌陷但无严重腰椎骨质增生的Modic改变发生率较高。椎间盘塌陷伴严重腰椎骨质增生的患者与严重腰椎骨质增生但无椎间盘塌陷的患者之间，Modic改变发生率无显著差异。
