Berg Andrew James, Ahmadje Uzair, Jayanna Harsha Haraluru, Trégouët Paul, Sanville Philip, Kapoor Vikas
Spinal Unit, Stepping Hill Hospital, Stockport, United Kingdom.
Health Education North West, Manchester, United Kingdom.
J Clin Orthop Trauma. 2020 Sep-Oct;11(5):932-936. doi: 10.1016/j.jcot.2020.07.021. Epub 2020 Jul 28.
Retrospective Cohort Study.
Low back pain (LBP) and radiculopathy present a significant burden to patients and healthcare systems. Lumbar disc degeneration (LDD) is associated with LBP. While the prevalence of LDD in older, symptomatic, patients has been extensively documented there has been little describing the prevalence in younger patients.
1011 patients aged 20-30 years, who had undergone Magnetic Resonance Imaging (MRI), for investigation of LBP and or radiculopathy, over a 9-year period were identified. Those who had previous surgery, congenital deformities or unavailable imaging were excluded. A single surgeon evaluated the MRI images of 730 patients and classified each lumbar disc according to the Pfirrmann classification. 105 randomly selected patient's imaging was reviewed again by the primary reviewer and by a consultant musculoskeletal radiologist with the kappa coefficients for inter-rater and intra-rater agreement calculated.
Of the 730 patients, 428 (58.6%) had MRI evidence of LDD (Pfirrmann III, IV, V). 255 (59.6%) demonstrated single level pathology and 173 (41.4%) multilevel involvement. There was very high intra/inter observer agreement with kappa coefficients for intra-observer agreement from 0.65 to 0.98 and inter-observer agreement from 0.51 to 0.88.
This is the largest study to document the prevalence of LDD in a symptomatic young cohort. A large prospective study including non-symptomatic patients and information on associated factors would add further information. Given the considerably higher than anticipated prevalence identified in this study and the significant burden associated with LBP this study should encourage such further research.
回顾性队列研究。
腰痛（LBP）和神经根病给患者及医疗系统带来了沉重负担。腰椎间盘退变（LDD）与腰痛相关。虽然老年有症状患者中LDD的患病率已有大量文献记载，但关于年轻患者中LDD患病率的描述却很少。
确定了在9年期间因腰痛和/或神经根病接受磁共振成像（MRI）检查的1011例20至30岁患者。排除曾接受过手术、有先天性畸形或影像资料缺失的患者。一名外科医生评估了730例患者的MRI图像，并根据Pfirrmann分类法对每个腰椎间盘进行分类。主要评估者和一名肌肉骨骼放射科顾问再次对105例随机选择患者的影像进行了复查，并计算了评分者间和评分者内一致性的kappa系数。
在730例患者中，428例（58.6%）有LDD的MRI证据（Pfirrmann III、IV、V级）。255例（59.6%）表现为单节段病变，173例（41.4%）为多节段受累。评分者内/间一致性非常高，评分者内一致性的kappa系数为0.65至0.98，评分者间一致性的kappa系数为0.51至0.88。
这是记录有症状年轻队列中LDD患病率的最大规模研究。一项纳入无症状患者及相关因素信息的大型前瞻性研究将提供更多信息。鉴于本研究中确定的患病率远高于预期，且腰痛相关负担重大，本研究应鼓励开展此类进一步研究。
