一项大型人群研究中椎间盘退变、终板信号改变和许莫氏结节的联合与腰痛的关联：和歌山脊柱研究
The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama Spine Study.
作者信息
Teraguchi Masatoshi, Yoshimura Noriko, Hashizume Hiroshi, Muraki Shigeyuki, Yamada Hiroshi, Oka Hiroyuki, Minamide Akihito, Nakagawa Hiroyuki, Ishimoto Yuyu, Nagata Keiji, Kagotani Ryohei, Tanaka Sakae, Kawaguchi Hiroshi, Nakamura Kozo, Akune Toru, Yoshida Munehito
机构信息
Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, Wakayama 641-8510, Japan.
Department of Joint Disease Research, 22nd Century Medical and Research Center, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
出版信息
Spine J. 2015 Apr 1;15(4):622-8. doi: 10.1016/j.spinee.2014.11.012. Epub 2014 Nov 27.
BACKGROUND CONTEXT
Disc degeneration (DD) reportedly causes low back pain (LBP) and is often observed concomitantly with end plate signal change (ESC) and/or Schmorl node (SN) on magnetic resonance imaging.
PURPOSE
The purpose of this study was to examine the association between DD and LBP, considering ESC and/or SN presence, in a large population study.
STUDY DESIGN/SETTING: Cross-sectional population-based study in two regions of Japan.
PATIENT SAMPLE
Of 1,011 possible participants, data from 975 participants (324 men, 651 women; mean age, 66.4 years; range, 21-97 years) were included.
OUTCOME MEASURES
Prevalence of DD, ESC, and SN alone and in combination in the lumbar region and the association of these prevalence levels with LBP.
METHODS
Sagittal T2-weighted images were used to assess the intervertebral spaces between L1-L2 and L5-S1. Disc degeneration was classified using the Pfirrmann classification system (grades 4 and 5 indicated degeneration); ESC was defined as a diffuse high signal change along either area of the end plate, and SN was defined as a small well-defined herniation pit with a surrounding wall of hypointense signal. Logistic regression analysis was used to determine the odds ratios (ORs) and confidence intervals (CIs) for LBP in the presence of radiographic changes in the lumbar region and at each lumbar intervertebral level, compared with patients without radiographic change, after adjusting for age, body mass index, and sex.
RESULTS
The prevalence of lumbar structural findings was as follows: DD alone, 30.4%; ESC alone, 0.8%; SN alone, 1.5%; DD and ESC, 26.6%; DD and SN, 12.3%; and DD, ESC, and SN, 19.1%. These lumbar structural findings were significantly associated with LBP in the lumbar region overall, as follows: DD, ESC, and SN, OR 2.17, 95% CI 1.2-3.9; L1-L2, OR 6.00, 95% CI 1.9-26.6; L4-L5, OR 2.56, 95% CI 1.4-4.9; and L5-S1, OR 2.81, 95% CI 1.1-2.3. The combination of DD and ESC was significantly associated with LBP as follows: L3-L4, OR 2.43, 95% CI 1.5-4.0; L4-L5, OR 1.82, 95% CI 1.2-2.8; and L5-S1, OR 1.60, 95% CI 1.1-2.3.
CONCLUSIONS
Our data suggest that DD alone is not associated with LBP. By contrast, the combination of DD and ESC was highly associated with LBP.
背景信息
据报道，椎间盘退变（DD）会导致下腰痛（LBP），并且在磁共振成像中常伴有终板信号改变（ESC）和/或施莫尔氏结节（SN）。
目的
本研究的目的是在一项大型人群研究中，考虑ESC和/或SN的存在情况，检验DD与LBP之间的关联。
研究设计/地点：在日本两个地区进行的基于人群的横断面研究。
患者样本
在1011名可能的参与者中，纳入了975名参与者的数据（324名男性，651名女性；平均年龄66.4岁；范围21 - 97岁）。
观察指标
腰椎区域单独及合并存在的DD、ESC和SN的患病率，以及这些患病率水平与LBP的关联。
方法
使用矢状面T2加权图像评估L1 - L2和L5 - S1之间的椎间隙。采用Pfirrmann分类系统对椎间盘退变进行分类（4级和5级表示退变）；ESC定义为终板任一区域的弥漫性高信号改变，SN定义为有低信号壁环绕的边界清晰的小疝坑。在调整年龄、体重指数和性别后，使用逻辑回归分析确定腰椎区域及每个腰椎椎间水平存在影像学改变的患者与无影像学改变的患者相比，发生LBP的比值比（OR）和置信区间（CI）。
结果
腰椎结构异常的患病率如下：单独DD为30.4%；单独ESC为0.8%；单独SN为1.5%；DD和ESC为26.6%；DD和SN为12.3%；DD、ESC和SN为19.1%。这些腰椎结构异常在整个腰椎区域与LBP显著相关，如下：DD、ESC和SN，OR 2.17，95%CI 1.2 - 3.9；L1 - L2，OR 6.00，95%CI 1.9 - 26.6；L4 - L5，OR 2.56，95%CI 1.4 - 4.9；L5 - S1，OR 2.81，95%CI 1.1 - 2.3。DD和ESC的组合与LBP显著相关，如下：L3 - L4，OR 2.43，95%CI 1.5 - 4.0；L4 - L5，OR 1.82, 95%CI 1.2 - 2.8；L5 - S1，OR 1.60，95%CI 1.1 - 2.3。
结论
我们的数据表明，单独的DD与LBP无关。相比之下，DD和ESC的组合与LBP高度相关。
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