Munarriz Pablo M, Paredes Igor, Alén José F, Castaño-Leon Ana M, Cepeda Santiago, Hernandez-Lain Aurelio, Lagares Alfonso
Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, España.
Servicio de Neurocirugía, Hospital Universitario 12 de Octubre, Universidad Complutense, Madrid, España.
Neurocirugia (Astur : Engl Ed). 2018 Mar-Apr;29(2):79-85. doi: 10.1016/j.neucir.2017.07.003. Epub 2017 Sep 28.
The use of histological degeneration scores in surgically-treated herniated lumbar discs is not common in clinical practice and its use has been primarily restricted to research. The objective of this study is to evaluate if there is an association between a higher grade of histological degeneration when compared with clinical or radiological parameters.
Retrospective consecutive analysis of 122 patients who underwent single-segment lumbar disc herniation surgery. Clinical information was available on all patients, while the histological study and preoperative magnetic resonance imaging were also retrieved for 75 patients. Clinical variables included age, duration of symptoms, neurological deficits, or affected deep tendon reflex. The preoperative magnetic resonance imaging was evaluated using Modic and Pfirrmann scores for the affected segment by 2 independent observers. Histological degeneration was evaluated using Weiler's score; the presence of inflammatory infiltrates and neovascularization, not included in the score, were also studied. Correlation and chi-square tests were used to assess the association between histological variables and clinical or radiological variables. Interobserver agreement was also evaluated for the MRI variables using weighted kappa.
No statistically significant correlation was found between histological variables (histological degeneration score, inflammatory infiltrates or neovascularization) and clinical or radiological variables. Interobserver agreement for radiological scores resulted in a kappa of 0.79 for the Pfirrmann scale and 0.65 for the Modic scale, both statistically significant.
In our series of patients, we could not demonstrate any correlation between the degree of histological degeneration or the presence of inflammatory infiltrates when compared with radiological degeneration scales or clinical variables such as the patient's age or duration of symptoms.
在临床实践中，组织学退变评分在手术治疗的腰椎间盘突出症中的应用并不常见，其应用主要局限于研究。本研究的目的是评估与临床或放射学参数相比，更高等级的组织学退变之间是否存在关联。
对122例行单节段腰椎间盘突出症手术的患者进行回顾性连续分析。所有患者均有临床资料，同时还检索了75例患者的组织学研究和术前磁共振成像。临床变量包括年龄、症状持续时间、神经功能缺损或受累的深腱反射。由2名独立观察者使用Modic和Pfirrmann评分对患节段的术前磁共振成像进行评估。使用Weiler评分评估组织学退变；还研究了评分中未包括的炎性浸润和新生血管形成的情况。使用相关性和卡方检验评估组织学变量与临床或放射学变量之间的关联。还使用加权kappa评估MRI变量的观察者间一致性。
未发现组织学变量（组织学退变评分、炎性浸润或新生血管形成）与临床或放射学变量之间存在统计学显著相关性。放射学评分的观察者间一致性在Pfirrmann量表中kappa为0.79，在Modic量表中为0.65，两者均具有统计学显著性。
在我们的患者系列中，与放射学退变量表或临床变量（如患者年龄或症状持续时间）相比，我们未能证明组织学退变程度或炎性浸润的存在之间存在任何相关性。
