青少年特发性脊柱侧凸后路 Harrington 器械固定后 27 至 45 年未融合节段的 Modic 改变和椎间盘退变：与健康对照组的比较。
Modic Changes and Disc Degeneration of Nonfused Segments 27 to 45 Years After Harrington Instrumentation for Adolescent Idiopathic Scoliosis: Comparison to Healthy Controls.
机构信息
Department of Orthopaedic Surgery, St. Marianna University School of Medicine, Kawasaki, Japan.
Department of Orthopedic Surgery, Seirei Sakura Citizen Hospital, Sakura, Japan.
出版信息
Spine (Phila Pa 1976). 2018 Apr 15;43(8):556-561. doi: 10.1097/BRS.0000000000002362.
STUDY DESIGN
A case-control study.
OBJECTIVE
The aim of this study was to investigate the long-term prevalence of the Modic changes and disc degeneration in the nonfused segments of the surgically treated adolescent idiopathic scoliosis (AIS) patients and compare with age- and sex-matched healthy controls.
SUMMARY OF BACKGROUND DATA
No studies have looked at the association between Modic changes and low back pain in patients who underwent AIS surgery many years ago.
METHODS
Study subjects consisted of 194 patients with AIS who underwent spinal fusion with Harrington instrumentation between 1968 and 1987. Twenty-six patients (AIS group) underwent lumbar magnetic resonance imaging (MRI), whole spine X-ray, and patient-reported outcomes evaluations [Scoliosis Research Society-22 Patient Questionnaire (SRS-22), Oswestry Disability Index (ODI)]. The mean duration of follow-up observation was 36.1 years. The lowest fusion vertebra was used as follows: T12: 2 patients, L1: 4, L2: 11, L3: 6, L4: 2, L5: 1. Twenty-nine healthy age- and sex-matched individuals were selected as a control (CTR) group.
RESULTS
On the basis of MRI findings, a significantly higher percentage of subjects showed Modic changes in the AIS group (AIS group: 57.7%, CTR group: 13.8%). There were no significant differences in the percentage of subjects with disc degeneration rated Pfirrmann grade 4 or higher (AIS group: 61.5%, CTR group: 65.5%). SRS-22 scores for function and self-image were significantly lower in the AIS group. ODI was significantly worse in the AIS group. Modic changes in AIS group were found in the concave side of the curve in 61.9%. The magnitude of lumbar coronal curve was found to be a significant risk factor of Modic changes.
CONCLUSION
Modic changes were observed in 57.7% of AIS patients 27 years or more after spinal fusion with Harrington instrumentation. The magnitude of lumbar coronal curve was found to be a significant risk factor of Modic changes. Modic change occurred at a higher frequency in AIS patients than CTR individuals, with lower function and worse ODI scores.
LEVEL OF EVIDENCE
研究设计
病例对照研究。
目的
本研究旨在探讨接受手术治疗的青少年特发性脊柱侧凸（AIS）患者非融合节段 Modic 改变和椎间盘退变的长期患病率，并与年龄和性别匹配的健康对照组进行比较。
背景资料概要
没有研究探讨过多年前接受 AIS 手术的患者中 Modic 改变与下腰痛之间的关系。
方法
研究对象包括 194 例 1968 年至 1987 年间接受 Harrington 器械脊柱融合术的 AIS 患者。26 例患者（AIS 组）接受了腰椎磁共振成像（MRI）、全脊柱 X 线片和患者报告的结果评估[脊柱侧凸研究协会 22 项问卷（SRS-22）、Oswestry 残疾指数（ODI）]。平均随访观察时间为 36.1 年。最低融合椎骨如下：T12：2 例，L1：4 例，L2：11 例，L3：6 例，L4：2 例，L5：1 例。选择 29 名年龄和性别匹配的健康个体作为对照组（CTR 组）。
结果
根据 MRI 结果，AIS 组中出现 Modic 改变的患者比例明显更高（AIS 组：57.7%，CTR 组：13.8%）。评定为 Pfirrmann 分级 4 或更高的椎间盘退变患者比例无显著差异（AIS 组：61.5%，CTR 组：65.5%）。AIS 组的 SRS-22 功能和自我形象评分明显较低。ODI 在 AIS 组中明显更差。AIS 组的 Modic 改变发生在曲线凹侧的 61.9%。腰椎冠状面曲线的幅度被发现是 Modic 改变的一个显著危险因素。
结论
Harrington 器械脊柱融合术后 27 年或以上的 AIS 患者中，发现 57.7%存在 Modic 改变。腰椎冠状面曲线的幅度被发现是 Modic 改变的一个显著危险因素。AIS 患者的 Modic 改变发生率高于 CTR 个体，功能较低，ODI 评分更差。
证据水平
4 级。
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