年轻腰痛患者的椎间盘退变：一项前瞻性 30 年随访 MRI 研究。
Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.
机构信息
University of Helsinki, Helsinki, Finland.
Department of Hand Surgery, Töölö Hospital, Helsinki University Hospital, Finland.
出版信息
Spine (Phila Pa 1976). 2020 Oct 1;45(19):1341-1347. doi: 10.1097/BRS.0000000000003548.
STUDY DESIGN
A prospective follow-up study.
OBJECTIVE
The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up.
SUMMARY OF BACKGROUND DATA
MRI is an accurate method for studying degenerative changes in intervertebral discs. Decreased signal intensity (SI) can be used as indication of decreased water content. Long-term prognosis of early DD remains unclear.
METHODS
In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI. The images were evaluated for decreased SI and other degenerative changes. Association between decreased SI of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. Association between decreased baseline SI and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.
RESULTS
The total number of lumbar discs with decreased SI increased from 23 of 130 (18%) to 92 of 130 (71%)-from 0.9 to 3.5 per subject during the follow-up. Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased SI at baseline were more likely to have severely decreased SI at follow-up, compared to healthy discs (57% vs. 11%, P < 0.001). Other degenerative changes were also more common in these discs. Severity of DD at baseline did not have a significant association with current pain or disability.
CONCLUSION
In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.
LEVEL OF EVIDENCE
研究设计
前瞻性随访研究。
目的
本研究旨在探讨年轻腰痛（LBP）患者早期腰椎间盘退变（DD）是否预示着 30 年随访中退行性变化、疼痛或残疾的进展。
背景资料概要
MRI 是研究椎间盘退行性变化的一种准确方法。信号强度（SI）降低可作为含水量降低的指标。早期 DD 的长期预后仍不清楚。
方法
在一项早期研究中，对 75 名 20 岁腰痛的应征者进行了腰椎 MRI 检查。在 30 年的随访中，联系了这些受试者；69 名受试者中有 35 名填写了疼痛和残疾问卷，其中 35 名中有 26 名也接受了临床和 MRI 复查。评估了 SI 降低的椎间盘和同一椎间盘空间中退行性变化更严重的椎间盘之间的关联。采用 Fisher 确切检验分析基线时椎间盘 SI 降低与随访时同一椎间盘空间中更严重退行性变化之间的关系。采用 Kruskal-Wallis H 检验分析基线时 SI 降低与问卷中疼痛/残疾评分之间的关系。
结果
总的来说，腰椎间盘 SI 降低的数量从基线时的 130 个椎间盘中的 23 个（18%）增加到随访时的 130 个椎间盘中的 92 个（71%），即每个受试者的数量从 0.9 个增加到 3.5 个。DD 的分布从 L4-L5 和 L5-S1 椎间盘为主变为四个最下面的椎间盘几乎均匀分布。与健康椎间盘相比，基线时 SI 轻度降低的椎间盘更有可能在随访时出现严重的 SI 降低（57% vs. 11%，P<0.001）。这些椎间盘也更常见其他退行性变化。基线时 DD 的严重程度与当前疼痛或残疾无显著相关性。
结论
在年轻的 LBP 患者中，腰椎间盘的早期退变预示着相应椎间盘的退行性变化进展，但不能预测疼痛、残疾或临床症状。
证据等级
4 级。
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