脊柱-骨盆参数对退行性胸腰椎/腰椎后凸患者终板 Modic 改变发生率的影响。
The influence of spinal-pelvic parameters on the prevalence of endplate Modic changes in degenerative thoracolumbar/lumbar kyphosis patients.
机构信息
Department of Spinal Surgery, Peking University People's Hospital, Beijing, China.
出版信息
PLoS One. 2018 May 15;13(5):e0197470. doi: 10.1371/journal.pone.0197470. eCollection 2018.
BACKGROUND
The typical degeneration of the vertebral endplate shown in MRI imaging is Modic change. The aim of this study was to observe the distribution of the Modic changes of vertebral endplate in degenerative thoracolumbar/lumbar kyphosis (DTK/LK) patients and analyse the correlation between spinal-pelvic parameters and Modic changes.
METHODS
The imaging data of 58 patients diagnosed with DTK/LK (coronal Cobb angle<10°with sagittal imbalance) in our hospital from March 2016 to May 2017 were reviewed retrospectively. Observe the prevalence, type and distribution characteristics of Modic changes occurred at the vertebral endplate from T10 to S1;analyse the correlation between Modic changes and disc degeneration, the sagittal vertical axis (SVA), thoracic kyphosis (TK), thoracolumbar kyphosis (TLK), lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI).
RESULTS
Of the 928 intervertebral endplates from 58 patients, Modic changes occurred at 90 endplates (9.7%) of 30 patients (51.7%). 5 endplates (0.5%) of 3 patients (5.2%) were classified as type I, 68 endplates (7.3%) of 25 patients (43.1%) as type II, 17 endplates (1.8%) of 9 patients (15.5%) as type III. The location of the degenerative endplates: 2 (2.2%) superior and inferior endplates of L1, 3 (3.3%) inferior endplates of T11and T12, 4 (4.4%) superior endplates of L2, 6 (6.7%) inferior endplates of L2 and L4, 8 (8.9%) superior endplates of S1, 9 (10%) superior endplates of L3, 11 (12.2%) inferior endplates of L3 and L5 and superior endplates of L4, 12 (13.3%) superior endplates of L5. Modic changes were significantly correlated with intervertebral disc degeneration (r = 0.414, p<0.01); the amount of Modic changes were significantly correlated with LL (r = -0.562, p = 0.012), SS (r = -0.46, p = 0.048), PT (r = 0.516, p = 0.024).
CONCLUSIONS
Most of the Modic changes of vertebral endplates in DTK/LK patients are type II which are prevalently located at L3/4, L4/5 and L5/S1. The Modic changes of vertebral endplates were found to be significantly correlated with disc degeneration, LL, SS, and PT.
背景
磁共振成像（MRI）显示的典型终板退变称为 Modic 改变。本研究旨在观察退行性胸腰椎/腰椎后凸（DTK/LK）患者的终板 Modic 改变分布，并分析脊柱-骨盆参数与 Modic 改变的相关性。
方法
回顾性分析 2016 年 3 月至 2017 年 5 月我院收治的 58 例 DTK/LK 患者（冠状 Cobb 角<10°合并矢状失平衡）的影像学资料。观察 T10 至 S1 节段终板 Modic 改变的发生率、类型和分布特征；分析 Modic 改变与椎间盘退变、矢状垂直轴（SVA）、胸椎后凸（TK）、胸腰椎后凸（TLK）、腰椎前凸（LL）、骶骨倾斜角（SS）、骨盆倾斜角（PT）和骨盆入射角（PI）的相关性。
结果
58 例患者的 928 个椎间终板中，30 例（51.7%）患者的 90 个终板（9.7%）出现 Modic 改变。3 例（5.2%）患者的 5 个终板（0.5%）为 I 型，25 例（43.1%）患者的 68 个终板（7.3%）为 II 型，9 例（15.5%）患者的 17 个终板（1.8%）为 III 型。退变终板的位置：L1 上、下终板各 2 个（2.2%），T11 和 T12 下终板各 3 个（3.3%），L2 上终板各 4 个（4.4%），L2 和 L4 下终板各 6 个（6.7%），S1 上终板各 8 个（8.9%），L3 上终板各 9 个（10%），L3 和 L5 下终板及 L4 上终板各 11 个（12.2%），L5 上终板各 12 个（13.3%）。Modic 改变与椎间盘退变显著相关（r = 0.414，p<0.01）；Modic 改变的程度与 LL（r = -0.562，p = 0.012）、SS（r = -0.46，p = 0.048）和 PT（r = 0.516，p = 0.024）显著相关。
结论
DTK/LK 患者的大多数终板 Modic 改变为 II 型，主要位于 L3/4、L4/5 和 L5/S1。终板 Modic 改变与椎间盘退变、LL、SS 和 PT 有显著相关性。
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