Lou Chao, Chen Hongliang, Mei Liangwei, Yu Weiyang, Zhu Kejun, Liu Feijun, Chen Zhenzhong, Xiang Guangheng, Chen Minjiang, Weng Qiaoyou, He Dengwei
1Department of Orthopaedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China 2Department of Orthopaedic Surgery, The Second Affiliated Hospital and Yuying Childern's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China 3Department of Interventional Radiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
Menopause. 2017 Oct;24(10):1136-1144. doi: 10.1097/GME.0000000000000902.
The aim of this study was to revisit and further investigate the association between menopause and disc degeneration in the lumbar spine using a magnetic resonance imaging-based eight-level grading system.
This study cohort comprised of 1,566 women and 1,382 age-matched men who were admitted for low back pain from June 2013 to October 2016. Data on age, weight, height, body mass index, age at natural menopause, and years since menopause (YSM) were obtained. Lumbar disc degeneration was assessed using a magnetic resonance imaging-based eight-level grading system.
After adjustment for the confounding factors of age, height, and weight, young age-matched men were more susceptible to disc degeneration than premenopausal women (P < 0.05). However, after menopause, postmenopausal women had a significant tendency to develop more severe disc degeneration than their age-matched men (P < 0.05), and also compared with premenopausal and perimenopausal women (P < 0.01). Postmenopausal women were divided into nine subgroups by every 5 YSM. When YSM was less than 15 years, a positive trend was observed between YSM and severity of disc degeneration, respectively, at L1/L2 (r = 0.241), L2/L3 (r = 0.193), L3/L4 (r = 0.191), L4/L5 (r = 0.165), L5/S1 (r = 0.153), and all lumbar discs (r = 0.237) (P < 0.05 or 0.01). The analysis of covariance indicated a significant difference in each disc level (P < 0.05 or 0.01) between every two groups. When YSM was more than 15 years, the significant difference, however, disappeared in each disc level (P > 0.05).
Menopause is associated with lumbar disc degeneration. The association occurred in the first 15 YSM, suggesting estrogen deficiency might be a risk factor of disc degeneration of the lumbar spine. Further studies need to be carried out for deciding whether age or menopause plays a more important role in the progression of disc degeneration in the lumbar spine.
本研究旨在使用基于磁共振成像的八级分级系统，重新审视并进一步研究绝经与腰椎间盘退变之间的关联。
本研究队列包括2013年6月至2016年10月因腰痛入院的1566名女性和1382名年龄匹配的男性。获取了年龄、体重、身高、体重指数、自然绝经年龄和绝经年限（YSM）的数据。使用基于磁共振成像的八级分级系统评估腰椎间盘退变情况。
在对年龄、身高和体重等混杂因素进行调整后，年龄匹配的年轻男性比绝经前女性更容易发生椎间盘退变（P<0.05）。然而，绝经后，绝经后女性比年龄匹配的男性有更严重椎间盘退变的显著趋势（P<0.05），并且与绝经前和围绝经期女性相比也有显著差异（P<0.01）。绝经后女性按每5年YSM分为9个亚组。当YSM小于15年时，在L1/L2（r=0.241）、L2/L3（r=0.193）、L3/L4（r=0.191）、L4/L5（r=0.165）、L5/S1（r=0.153）以及所有腰椎间盘（r=0.237）处，分别观察到YSM与椎间盘退变严重程度之间呈正相关趋势（P<0.05或0.01）。协方差分析表明每两组之间在每个椎间盘水平存在显著差异（P<0.05或0.01）。当YSM超过15年时，然而，每个椎间盘水平的显著差异消失（P>0.05）。
绝经与腰椎间盘退变相关。这种关联发生在绝经后的前15年，提示雌激素缺乏可能是腰椎间盘退变的一个危险因素。需要进一步开展研究以确定年龄或绝经在腰椎间盘退变进展中哪个起更重要的作用。
