Markotić Vedran, Zubac Damir, Miljko Miro, Šimić Goran, Zalihić Amra, Bogdan Gojko, Radančević Dorijan, Šimić Ana Dugandžić, Mašković Josip
Department of Clinical Radiology, University Hospital, Mostar, Bosnia and Herzegovina.
Science and Research Centre Koper, Institute for Kinesiology Research, Koper, Slovenia.
Cent Eur J Public Health. 2017 Sep;25(3):245-250. doi: 10.21101/cejph.a4897.
The aim of this study was to document the prevalence of degenerative intervertebral disc changes in the patients who previously reported symptoms of neck pain and to determine the influence of education level on degenerative intervertebral disc changes and subsequent chronic neck pain.
One hundred and twelve patients were randomly selected from the University Hospital in Mostar, Bosna and Herzegovina, (aged 48.5±12.7 years) and submitted to magnetic resonance imaging (MRI) of the cervical spine. MRI of 3.0 T (Siemens, Skyrim, Erlangen, Germany) was used to obtain cervical spine images. Patients were separated into two groups based on their education level: low education level (LLE) and high education level (HLE). Pfirrmann classification was used to document intervertebral disc degeneration, while self-reported chronic neck pain was evaluated using the previously validated Oswestry questionnaire.
The entire logistic regression model containing all predictors was statistically significant, (χ(3)=12.2, p=0.02), and was able to distinguish between respondents who had chronic neck pain and vice versa. The model explained between 10.0% (Cox-Snell R) and 13.8% (Nagelkerke R) of common variance with Pfirrmann classification, and it had the strength to discriminate and correctly classify 69.6% of patients. The probability of a patient being classified in the high or low group of degenerative disc changes according to the Pfirrmann scale was associated with the education level (Wald test: 5.5, p=0.02). Based on the Pfirrmann assessment scale, the HLE group was significantly different from the LLE group in the degree of degenerative changes of the cervical intervertebral discs (U=1,077.5, p=0.001).
A moderate level of intervertebral disc degenerative changes (grade II and III) was equally matched among all patients, while the overall results suggest a higher level of education as a risk factor leading to cervical disc degenerative changes, regardless of age differences among respondents.
本研究旨在记录既往有颈部疼痛症状患者的椎间盘退变情况，并确定教育水平对椎间盘退变及后续慢性颈部疼痛的影响。
从波斯尼亚和黑塞哥维那莫斯塔尔大学医院随机选取112例患者（年龄48.5±12.7岁），对其进行颈椎磁共振成像（MRI）检查。采用3.0T（西门子，斯凯瑞姆，德国埃尔朗根）MRI获取颈椎图像。根据教育水平将患者分为两组：低教育水平组（LLE）和高教育水平组（HLE）。采用Pfirrmann分类法记录椎间盘退变情况，同时使用先前验证过的奥斯威斯利问卷评估自我报告的慢性颈部疼痛。
包含所有预测因素的整个逻辑回归模型具有统计学意义（χ(3)=12.2，p=0.02），能够区分患有慢性颈部疼痛的受访者及反之情况。该模型用Pfirrmann分类法解释了10.0%（考克斯 - 斯内尔R）至13.8%（纳格尔克R）的共同方差，且有能力区分并正确分类69.6%的患者。根据Pfirrmann量表，患者被分类为椎间盘退变高分组或低分组的概率与教育水平相关（Wald检验：5.5，p=0.02）。根据Pfirrmann评估量表，HLE组与LLE组在颈椎间盘退变程度上有显著差异（U=1,077.5，p=0.001）。
所有患者中中度椎间盘退变变化（II级和III级）相当，而总体结果表明较高的教育水平是导致颈椎间盘退变变化的一个风险因素，无论受访者年龄差异如何。
