终板病理学与慢性下腰痛患者报告症状的关系取决于腰椎旁肌质量。
The Relationship Between Endplate Pathology and Patient-reported Symptoms for Chronic Low Back Pain Depends on Lumbar Paraspinal Muscle Quality.
机构信息
Department of Orthopaedic Surgery, University of California, San Francisco, CA.
Department of Orthopaedic Surgery, New York University, New York, NY.
出版信息
Spine (Phila Pa 1976). 2019 Jul 15;44(14):1010-1017. doi: 10.1097/BRS.0000000000003035.
STUDY DESIGN
Cross-sectional cohort study of chronic low back pain (CLBP) patients and matched controls.
OBJECTIVE
To explore the interplay between vertebral endplate damage and adjacent paraspinal muscle (PSM) quality, and to test their association in a cohort of patients with CLBP and matched controls.
SUMMARY OF BACKGROUND DATA
Nonspecific CLBP is challenging to diagnose, in part, due to uncertainty regarding the source of pain. Delineating interactions among potential CLBP mechanisms may enhance diagnosis and treatment customization.
METHODS
We collected advanced MRI imaging on 52 adult subjects, including 38 CLBP patients and 14 age- and sex-matched asymptomatic control subjects. Mean multifidus and erector spinae fat fraction (FF) was measured throughout the spine using an IDEAL MRI sequence. Presence of cartilage endplate (CEP) defects was determined at each disc level using UTE MRI. Logistic regression was used to test association of PSM FF, CEP defects, modic changes (MC), disc degeneration, and their interplay.
RESULTS
We observed that CEP defects were the strongest predictor of nonspecific CLBP (OR: 14.1, P < 0.01) even after adjusting for MC and disc degeneration (OR: 26.1, P = 0.04). PSM quality did not independently distinguish patient and control groups, except for patients with high self-reported disability.At specifically L4L5, CEP damage was most prevalent and CEP damage was significantly associated with CLBP (OR: 3.7, 95% CI: 1.2-21.5, P = 0.03). CEP damage at L4L5 was predictive of CLBP when adjacent to PSMs with greater FF (MF, OR 14.7, P = 0.04; ES, OR: 17.3, P = 0.03), but not when PSM FF was lower and comparable to values in control, asymptomatic subjects.
CONCLUSION
These results demonstrate the clinically important reciprocity between passive and dynamic spinal stabilizers, and support the notion that therapies targeting the PSMs may provide clinical benefit even in the presence of other spinal pathologies.
LEVEL OF EVIDENCE
研究设计
慢性下腰痛（CLBP）患者和匹配对照的横断面队列研究。
目的
探讨椎体终板损伤与相邻脊柱旁肌肉（PSM）质量之间的相互作用，并在 CLBP 患者和匹配对照队列中检验它们之间的关联。
背景资料概要
非特异性 CLBP 的诊断具有挑战性，部分原因是疼痛来源不确定。阐明潜在 CLBP 机制之间的相互作用可能会增强诊断和治疗的个性化。
方法
我们对 52 名成年受试者进行了高级 MRI 成像，包括 38 名 CLBP 患者和 14 名年龄和性别匹配的无症状对照受试者。使用 IDEAL MRI 序列在整个脊柱上测量多裂肌和竖脊肌脂肪分数（FF）的平均值。使用 UTE MRI 确定每个椎间盘水平的软骨终板（CEP）缺损情况。使用逻辑回归检验 PSM FF、CEP 缺损、Modic 改变（MC）、椎间盘退变及其相互作用与非特异性 CLBP 的关联。
结果
我们发现，即使在调整了 MC 和椎间盘退变后，CEP 缺损仍然是最能预测非特异性 CLBP 的因素（OR：14.1，P<0.01）（OR：26.1，P=0.04）。PSM 质量并不能独立区分患者和对照组，除了自我报告残疾较高的患者。在特定的 L4L5 水平，CEP 损伤最为普遍，且 CEP 损伤与 CLBP 显著相关（OR：3.7，95%CI：1.2-21.5，P=0.03）。当 L4L5 处的 CEP 损伤与脂肪分数更高的 PSM 相邻时（MF，OR 14.7，P=0.04；ES，OR：17.3，P=0.03），CEP 损伤可预测 CLBP，但当 PSM FF 较低且与对照无症状受试者的值相当时，CEP 损伤则无法预测 CLBP。
结论
这些结果表明了被动和动态脊柱稳定器之间具有临床重要的相互关系，并支持了靶向 PSM 的治疗方法即使在存在其他脊柱病变的情况下也可能提供临床益处的观点。
证据水平
4 级
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