国际腰椎研究学会奖获得者：椎体终板（莫迪克）改变是严重且致残性腰痛发作的独立危险因素。

ISSLS Prize Winner: Vertebral Endplate (Modic) Change is an Independent Risk Factor for Episodes of Severe and Disabling Low Back Pain.

作者信息

Määttä Juhani H, Wadge Sam, MacGregor Alex, Karppinen Jaro, Williams Frances M K

机构信息

*Medical Research Center Oulu and Center for Life Course Epidemiology Research, Oulu University Hospital and University of Oulu, Oulu, Finland; †Department of Twin Research and Genetic Epidemiology, King's College London, London, UK; and ‡Finnish Institute of Occupational Health, Health and Work Ability, and Disability Prevention Center, Oulu, Finland.

出版信息

Spine (Phila Pa 1976). 2015 Aug 1;40(15):1187-93. doi: 10.1097/BRS.0000000000000937.

DOI:10.1097/BRS.0000000000000937

PMID:25893353

Abstract

STUDY DESIGN

Longitudinal cohort study of twins representative of the general population.

OBJECTIVE

To assess the relationship between Modic change (MC) and severe, disabling low back pain (LBP), features of intervertebral disc degeneration (DD) and incident MC during 10-year follow-up.

SUMMARY OF BACKGROUND DATA

MC describes vertebral endplate and bone marrow lesions visible on magnetic resonance imaging (MRI). MC has been associated with DD. It remains unclear whether MC causes LBP independently or through association with DD. Moreover, association of MC with severe, disabling LBP is uncertain.

METHODS

Volunteers were recruited from the TwinsUK register to MRI and interview between 1996 and 2000 with a subset attending for follow-up a decade later. MC, DD (evaluated by loss of disc height and signal intensity, presence of disc bulge and anterior osteophytes) and Schmorl's nodes (SN) were determined on T2-weighted lumbar MR scans.

RESULTS

Complete data were available for 823 subjects at baseline and 429 at follow-up. Mean age at baseline was 54.0 years (range 32-70) with 96% females. The prevalence of MC was 32.2% at baseline and 48.7% at follow-up. Subjects with MC were older (P < 0.001) and more overweight (BMI: P = 0.026, weight: P < 0.001). At both baseline and follow-up, more subjects reporting severe LBP demonstrated MC (subjects with MC vs. without MC: 35.0% vs. 16.4% respectively, P < 0.001 at baseline; and 35.1% vs. 20.0% respectively, P < 0.001 at follow-up). In multivariable analyses, MC remained significantly associated with episodes of severe, disabling LBP (OR 1.58; 95% CI 1.04-2.41) after adjustment for age, BMI, DD, and SN at baseline. Loss of disc height and disc signal intensity were independently associated with prevalent MC at baseline, and disc height and disc bulge with incident MC during follow-up.

CONCLUSION

MC is an independent risk factor for episodes of severe and disabling LBP in middle-aged women. These observations support further work aimed at identifying the precise histology underlying MC.

LEVEL OF EVIDENCE

摘要

研究设计

对代表一般人群的双胞胎进行纵向队列研究。

目的

评估Modic改变（MC）与严重致残性下腰痛（LBP）、椎间盘退变（DD）特征以及10年随访期间MC发生情况之间的关系。

背景数据总结

MC描述了磁共振成像（MRI）上可见的椎体终板和骨髓病变。MC与DD有关。目前尚不清楚MC是独立导致LBP还是通过与DD相关联而导致LBP。此外，MC与严重致残性LBP的关联尚不确定。

方法

从TwinsUK登记册招募志愿者进行MRI检查并在1996年至2000年期间进行访谈，其中一部分在十年后接受随访。在T2加权腰椎MR扫描上确定MC、DD（通过椎间盘高度和信号强度丧失、椎间盘膨出和前缘骨赘的存在来评估）和Schmorl结节（SN）。

结果

基线时823名受试者和随访时429名受试者有完整数据。基线时平均年龄为54.0岁（范围32 - 70岁），女性占96%。MC的患病率在基线时为32.2%，随访时为48.7%。有MC的受试者年龄更大（P < 0.001）且超重更多（BMI：P = 0.026，体重：P < 0.001）。在基线和随访时，更多报告严重LBP的受试者有MC（有MC的受试者与无MC的受试者：分别为35.0%对16.4%，基线时P < 0.001；分别为35.1%对20.0%，随访时P < 0.001）。在多变量分析中，在对基线时的年龄、BMI、DD和SN进行调整后，MC仍与严重致残性LBP发作显著相关（OR 1.58；95% CI 1.04 - 2.41）。椎间盘高度和椎间盘信号强度丧失在基线时与普遍存在的MC独立相关，而椎间盘高度和椎间盘膨出在随访期间与MC发生相关。