椎体终板缺陷作为椎间盘退变的起始因素：在普通人群中终板缺陷与椎间盘退变之间存在很强的关联。
Vertebral Endplate Defect as Initiating Factor in Intervertebral Disc Degeneration: Strong Association Between Endplate Defect and Disc Degeneration in the General Population.
机构信息
Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland.
Faculty of Medicine, Orthopaedic and Rehabilitation Hospital "Prim. dr.Martin Horvat", Josip Juraj Strossmayer University of Osijek, Rovinj, Croatia.
出版信息
Spine (Phila Pa 1976). 2018 Mar 15;43(6):412-419. doi: 10.1097/BRS.0000000000002352.
STUDY DESIGN
Cross-sectional study of spine magnetic resonance in a population, predominantly female, sample.
OBJECTIVE
To determine the relationship between vertebral endplate defect and intervertebral disc degeneration (DD) in general population.
SUMMARY OF BACKGROUND DATA
Precise understanding of the mechanisms leading to DD development is lacking. In a degenerating disc, mechanical and structural changes lead to further worsening of disc integrity. Increasing attention has been paid to vertebral endplate defects as having a possible role in the etiopathogenesis of DD.
METHODS
The study population comprised 831 twin volunteers from TwinsUK (mean age 54 ± 8 yr, 95.8% female). Lumbar T2-weighted magnetic resonance images were coded for endplate defects from 8310 endplates into six grades. Total endplate score (TEP score) was achieved by summing both endplate defect grades from the same disc level. DD was evaluated using two different classifications; Pfirrmann grading, and a quantitative trait for DD based on a 4-point grading system. Multivariable regression analysis was used to determine relationships between the traits of interest and the known risk factors for DD, age, and body mass index (BMI). A receiver operator curve for TEP score predicting DD was generated, and survival analysis paired with Cox proportional hazards models analysis performed.
RESULTS
There was statistically significant association between DD and age and BMI. These associations lost significance when TEP score was included as predictor in multivariable model. TEP score was strongly and independently associated at every lumbar disc level with DD (Pfirmann P≤0.001; 4-point grading systems P < 1e-16). A cut-off point score of 5 for TEP score was found above which there was a higher DD prevalence. Across all age subgroups, probabilities of having DD were significantly increased in those considered TEP score positive (≥5).
CONCLUSION
Our large, population-based study has shown that endplate defect was strongly and independently associated with DD at every lumbar disc level. These results provide a mechanism by which increasing age and BMI predispose to DD.
LEVEL OF EVIDENCE
研究设计
人群脊柱磁共振的横断面研究，主要为女性样本。
目的
确定普遍人群中椎体终板缺陷与椎间盘退变（DD）之间的关系。
背景资料概要
对导致 DD 发展的机制缺乏准确的理解。在退变的椎间盘中，力学和结构的变化导致椎间盘完整性进一步恶化。人们越来越关注椎体终板缺陷在 DD 的发病机制中可能具有的作用。
方法
研究人群包括来自 TwinsUK 的 831 对双胞胎志愿者（平均年龄 54±8 岁，95.8%为女性）。对 8310 个终板的腰椎 T2 加权磁共振图像进行编码，将终板缺陷分为 6 个等级。通过对同一椎间盘水平的两个终板缺陷等级进行求和，得出总终板评分（TEP 评分）。DD 采用两种不同的分类方法进行评估；Pfirrmann 分级和基于 4 分分级系统的 DD 定量特征。多变量回归分析用于确定感兴趣的特征与 DD 的已知危险因素、年龄和体重指数（BMI）之间的关系。生成 TEP 评分预测 DD 的受试者工作特征曲线，并进行生存分析和 Cox 比例风险模型分析。
结果
DD 与年龄和 BMI 之间存在统计学显著关联。当 TEP 评分作为多变量模型的预测因子时，这些关联失去了意义。TEP 评分与每一节段的腰椎间盘均与 DD 呈强烈且独立相关（Pfirrmann P≤0.001；4 分分级系统 P<1e-16）。发现 TEP 评分的截断点分数为 5 分以上，DD 的患病率较高。在所有年龄亚组中，TEP 评分阳性（≥5 分）的个体发生 DD 的概率显著增加。
结论
我们的大型、基于人群的研究表明，终板缺陷与每一节段的腰椎间盘均与 DD 呈强烈且独立相关。这些结果提供了一种机制，即年龄和 BMI 的增加导致 DD 的易感性增加。
证据水平
2。
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