一项基于一般人群队列研究数据的探索性研究，评估了 MRI 评估的腰椎间盘退变的不同定义和阈值及其与腰痛的关系。
An exploratory study of different definitions and thresholds for lumbar disc degeneration assessed by MRI and their associations with low back pain using data from a cohort study of a general population.
机构信息
Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
Health Sciences Research Centre, UCL University College, Odense, Denmark.
出版信息
BMC Musculoskelet Disord. 2020 Apr 17;21(1):253. doi: 10.1186/s12891-020-03268-4.
BACKGROUND
Lumbar disc degeneration seen on magnetic resonance imaging (MRI) is defined as loss of signal intensity and/or disc height, alone or in combination with other MRI findings. The MRI findings and thresholds used to define disc degeneration vary in the literature, and their associations with low back pain (LBP) remain uncertain.
OBJECTIVE
To explore how various thresholds of lumbar disc degeneration alter the association between disc degeneration and self-reported LBP.
METHODS
An exploratory, cross-sectional cohort study of a general population. Participants in the cohort 'Backs-on-Funen' had MRI scans and completed questionnaires about LBP at ages 41, 45 and 49 years. The MRI variables, signal intensity (Grades 0-3) and disc height (Grades 0-3), were dichotomised at different thresholds. Logistic regression analyses were used to determine associations. Arbitrarily, a difference in odds ratio (OR) of > 0.5 between thresholds was considered clinically relevant. Receiver Operating Characteristic curves were used to investigate differences between diagnostic values at each threshold.
RESULTS
At age 41, the difference in ORs between signal loss and LBP exceeded 0.5 between the thresholds of ≥2 (OR = 2.02) and = 3 (OR = 2.57). Difference in area under the curves (AUC) was statistically significant (p = 0.02). At ages 45 and 49, the difference in ORs exceeded 0.5 between the thresholds of ≥2 and = 3, but the differences between AUC were not statistically significant. At age 41, the difference in ORs between disc height loss and LBP at the thresholds of ≥1 (OR = 1.44) and ≥ 2 (OR = 2.53) exceeded 0.5. Differences in AUC were statistically significant (p = 0.004). At age 49, differences in ORs exceeded 0.5 (OR = 2.49 at the ≥1 threshold, 1.84 at ≥2 and 0.89 at =3). Differences between AUC were not statistically significant.
CONCLUSION
The results suggest that the thresholds used to define the presence of lumbar disc degeneration influence how strongly it is associated with LBP. Thresholds at more severe grades of disc signal and disc height loss were more strongly associated with LBP at age 41, but thresholds at moderate grades of disc degeneration were most strongly associated with LBP at ages 45 and 49.
背景
磁共振成像（MRI）所见的腰椎间盘退变定义为信号强度和/或椎间盘高度的丧失，单独或与其他 MRI 发现一起出现。文献中 MRI 发现和用于定义椎间盘退变的阈值各不相同，其与腰痛（LBP）的关系仍不确定。
目的
探讨腰椎间盘退变的各种阈值如何改变椎间盘退变与自我报告的腰痛（LBP）之间的关联。
方法
对一般人群进行探索性、横断面队列研究。队列“Backs-on-Funen”中的参与者在 41、45 和 49 岁时进行 MRI 扫描并完成腰痛问卷。MRI 变量信号强度（等级 0-3）和椎间盘高度（等级 0-3）在不同阈值下分为两部分。使用逻辑回归分析确定关联。任意地，认为阈值之间的优势比（OR）差异大于 0.5 具有临床意义。接收者操作特征曲线用于研究每个阈值的诊断值之间的差异。
结果
在 41 岁时，信号丢失与 LBP 之间的 OR 差异在≥2（OR=2.02）和≥3（OR=2.57）之间的阈值之间超过 0.5。曲线下面积（AUC）的差异具有统计学意义（p=0.02）。在 45 岁和 49 岁时，≥2 和≥3 之间的阈值之间的 OR 差异超过 0.5，但 AUC 之间的差异无统计学意义。在 41 岁时，椎间盘高度丧失与 LBP 之间的 OR 差异在≥1（OR=1.44）和≥2（OR=2.53）之间的阈值超过 0.5。AUC 的差异具有统计学意义（p=0.004）。在 49 岁时，OR 差异超过 0.5（≥1 阈值时为 OR=2.49，≥2 时为 1.84，=3 时为 0.89）。AUC 之间的差异无统计学意义。
结论
结果表明，用于定义腰椎间盘退变存在的阈值会影响其与 LBP 之间的关联程度。在 41 岁时，椎间盘信号和椎间盘高度丧失程度更严重的分级与 LBP 的相关性更强，但在 45 岁和 49 岁时，椎间盘退变程度中度分级与 LBP 的相关性最强。
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