Farshad-Amacker Nadja A, Hughes Alexander, Herzog Richard J, Seifert Burkhardt, Farshad Mazda
MRI, Radiology Department, Hospital for Special Surgery, New York, NY, USA.
Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
Eur Radiol. 2017 Jun;27(6):2507-2520. doi: 10.1007/s00330-016-4584-z. Epub 2016 Oct 5.
The association of disc degeneration (DD) and vertebral endplate degeneration (EPD) is still not well understood. This study aimed to find segmental predictive risk factors for DD and EPD and to illuminate associations of the disc, endplate and bone marrow changes in the process of degeneration.
After institutional review board approval, 450 lumbar levels, followed up with MRI for at least 4 years, were retrospectively graded for DD according to Pfirrmann (PFG), for EPD according to the endplate score (EPS) and according to the presence, extension and type of Modic changes (MC). Clustered logistic regression and multivariate analysis was applied in nested, matched case-control subgroups to evaluate potential local risk factors for progression.
An EPS score of ≥4 was identified as an independent risk factor for progression of DD (OR = 2.32, 95%CI:1.07-5.01,p = 0.03) and MC (OR = 5.49,95%CI:2.30-13.10,p < 0.001). Progression of DD was significantly accompanied by progression or evolution of MC (OR = 12.25,95%CI:1.49-100.6,p = 0.02) and with progression of EPS (OR = 1.71, 95%CI:1.00-1.05, p = 0.01). Once advanced DD has occurred, it becomes a risk factor for progression in EPS (OR = 2.24,95%CI:1.23-4.12,p < 0.01).
The degenerative processes in the disc, endplate and bone marrow are highly associated. An EPS ≥ 4 is an independent risk factor for DD and MC progression in a population with low back pain.
• The degenerative processes in the disc, endplate and bone marrow are associated. • An endplate score ≥4 is a risk factor for DD and MC progression. • Modic changes are last to occur in the development of segmental intervertebral degeneration. • A new segmental grading system is suggested.
椎间盘退变（DD）与椎体终板退变（EPD）之间的关联仍未完全明确。本研究旨在寻找DD和EPD的节段性预测风险因素，并阐明退变过程中椎间盘、终板和骨髓变化之间的关联。
经机构审查委员会批准，对450个腰椎节段进行回顾性研究，这些节段均接受了至少4年的MRI随访，根据Pfirrmann（PFG）对DD进行分级，根据终板评分（EPS）以及Modic改变（MC）的存在、范围和类型对EPD进行分级。在嵌套、匹配的病例对照亚组中应用聚类逻辑回归和多变量分析，以评估进展的潜在局部风险因素。
EPS评分≥4被确定为DD进展（OR = 2.32，95%CI：1.07 - 5.01，p = 0.03）和MC进展（OR = 5.49，95%CI：2.30 - 13.10，p < 0.001）的独立风险因素。DD的进展显著伴随着MC的进展或演变（OR = 12.25，95%CI：1.49 - 100.6，p = 0.02）以及EPS的进展（OR = 1.71，95%CI：1.00 - 1.05，p = 0.01）。一旦发生严重的DD，它就成为EPS进展的风险因素（OR = 2.24，95%CI：1.23 - 4.12，p < 0.01）。
椎间盘、终板和骨髓的退变过程高度相关。EPS≥4是腰痛人群中DD和MC进展的独立风险因素。
• 椎间盘、终板和骨髓的退变过程相关。• 终板评分≥4是DD和MC进展的风险因素。• Modic改变是节段性椎间盘退变发展中最后出现的。• 建议采用一种新的节段性分级系统。
