腰椎间盘突出症的大小或位置能否预测手术治疗的必要性？
Does the Size or Location of Lumbar Disc Herniation Predict the Need for Operative Treatment?
作者信息
Divi Srikanth N, Makanji Heeren S, Kepler Christopher K, Anderson D Greg, Goyal Dhruv K C, Warner Eric D, Galetta Matthew S, Hilibrand Alan S, Kaye I David, Kurd Mark F, Radcliff Kristen E, Rihn Jeffrey A, Woods Barrett I, Vaccaro Alexander R, Schroeder Gregory D
机构信息
387400Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
出版信息
Global Spine J. 2022 Mar;12(2):237-243. doi: 10.1177/2192568220948519. Epub 2020 Sep 16.
STUDY DESIGN
Retrospective cohort study.
OBJECTIVE
The goal of this study was to determine whether the absolute size (mm), relative size (% canal compromise), or location of a single-level, lumbar disc herniation (LDH) on axial and sagittal cuts of magnetic resonance imaging (MRI) were predictive of eventual surgical intervention.
METHODS
MRIs of 89 patients were reviewed, and patients were split into groups based on type of management received (34 nonoperative vs 55 microdiscectomy). Radiographic characteristics-including size of disc herniation (mm), size of spinal canal (mm), location of herniation on axial (central, paracentral, foraminal) and sagittal (disc level, suprapedicle, pedicle, infrapedicle) planes, and type of herniation (bulge, protrusion, extrusion, sequestration)-were measured by 2 independent, orthopedic spine fellows and compared between groups via univariate and multivariate analyses.
RESULTS
The operative group showed a significantly higher percentage of canal compromise (39.5% vs 31.1%, = .001) compared to the nonoperative group. Multiple logistic regression analysis showed higher odds of eventual operative intervention for a disc protrusion (odds ratio [OR] 6.30 [1.99, 19.86], = .002) or disc extrusion (OR 11.5 [1.63, 81.2], = .014) for Rater 1 and a higher odds of eventual surgical management for a paracentral location for both Rater 1 and Rater 2 (OR = 3.39 [1.25, 9.22], = .017, and OR = 5.46 [1.77, 16.8], = .003, respectively).
CONCLUSIONS
Disc herniations in a paracentral location were more likely to undergo operative treatment than those more centrally located, on axial MRI views.
研究设计
回顾性队列研究。
目的
本研究的目的是确定在磁共振成像（MRI）的轴位和矢状位图像上，单节段腰椎间盘突出症（LDH）的绝对大小（毫米）、相对大小（椎管狭窄百分比）或位置是否可预测最终的手术干预。
方法
回顾了89例患者的MRI图像，并根据接受的治疗类型将患者分为两组（34例非手术治疗与55例显微椎间盘切除术）。由两名独立的骨科脊柱专科医生测量影像学特征，包括椎间盘突出大小（毫米）、椎管大小（毫米）、轴位（中央型、旁中央型、椎间孔型）和矢状位（椎间盘水平、椎弓根上、椎弓根、椎弓根下）平面上的突出位置以及突出类型（膨出、突出、脱出、游离），并通过单因素和多因素分析对两组进行比较。
结果
与非手术组相比，手术组的椎管狭窄百分比显著更高（39.5%对31.1%，P = 0.001）。多因素logistic回归分析显示，对于评估者1，椎间盘突出（优势比[OR] 6.30 [1.99, 19.86]，P = 0.002）或椎间盘脱出（OR 11.5 [1.63, 81.2]，P = 0.014）最终进行手术干预的可能性更高；对于评估者1和评估者2，旁中央型位置最终进行手术治疗的可能性更高（OR分别为3.39 [1.25, 9.22]，P = 0.017和OR 5.46 [1.77, 16.8]，P = 0.003）。
结论
在轴位MRI图像上，旁中央型椎间盘突出比中央型椎间盘突出更有可能接受手术治疗。
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