Spine Lab, Department of Orthopedic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada.
Osteoarthritis Cartilage. 2021 May;29(5):707-717. doi: 10.1016/j.joca.2021.01.010. Epub 2021 Feb 18.
While cartilaginous endplate (CEP) avulsion is a common finding in discectomy due to lumbar disc herniation, its roles in residual back and leg pain, associations with Modic changes (MCs) and endplate defects (EPD) remain unknown.
Patients with a single-level lumbar disc herniation who underwent endoscopic discectomy were studied. On MR images, the adjacent endplates of the herniated disc were assessed for MCs and EPD. The presence of CEP avulsion was examined under endoscopic and visualized inspection. Back and leg pain were evaluated by a numeric rating scale (NRS) and the Oswestry Disability Index. Associations of CEP avulsion with adjacent MCs, EPD, and residual back and leg pain were examined. In addition, histological features of avulsed CEP were determined using gross staining and immunohistochemical methods.
A total of 386 patients were included. CEP avulsion was found in 166 (43%) patients, and adjacent MCs and EPD were observed in 117 (30.3%) and 139 (36%) patients. The presence of CEP avulsion was associated with greater age, adjacent MCs (OR = 2.60, 95%CI [1.61-4.19]) and EPD (OR = 1.63, 95%CI [1.03-2.57]). Among the 187 patients with ≥2 years follow-up, CEP avulsion was associated with residual back pain (OR = 2.49, 95%CI [1.29-4.82]) and leg pain (OR = 2.25, 95%CI [1.04-4.84]). Histologically, the avulsed CEP was characterized by multiple defects, apparent inflammation, and nucleus invasion, as well as the upregulation of IL-1β, caspase-1, and NLRP3 inflammasome.
CEP avulsion was associated with MCs, EPD, and residual back and leg pain after discectomy, which may be attributed to NLRP3 inflammasome related inflammations.
虽然软骨终板（CEP）撕脱在腰椎间盘突出症的椎间盘切除术中很常见，但它在残留的腰背和腿部疼痛中的作用、与 Modic 改变（MCs）和终板缺陷（EPD）的关联仍不清楚。
研究了接受内镜椎间盘切除术的单节段腰椎间盘突出症患者。在磁共振成像（MRI）上，评估了突出椎间盘相邻的终板是否存在 MCs 和 EPD。通过内镜和可视化检查检查 CEP 撕脱的存在。通过数字评分量表（NRS）和 Oswestry 残疾指数评估腰背和腿部疼痛。检查 CEP 撕脱与相邻 MCs、EPD 及残留腰背和腿部疼痛的关联。此外，使用大体染色和免疫组织化学方法确定撕脱的 CEP 的组织学特征。
共纳入 386 例患者。166 例（43%）患者存在 CEP 撕脱，117 例（30.3%）和 139 例（36%）患者存在相邻 MCs 和 EPD。CEP 撕脱的存在与年龄较大、相邻 MCs（OR=2.60，95%CI[1.61-4.19]）和 EPD（OR=1.63，95%CI[1.03-2.57]）有关。在 187 例随访时间≥2 年的患者中，CEP 撕脱与残留腰背疼痛（OR=2.49，95%CI[1.29-4.82]）和腿部疼痛（OR=2.25，95%CI[1.04-4.84]）有关。组织学上，撕脱的 CEP 表现为多个缺陷、明显的炎症和核入侵，以及 IL-1β、caspase-1 和 NLRP3 炎症小体的上调。
CEP 撕脱与椎间盘切除术后的 MCs、EPD 和残留的腰背和腿部疼痛有关，这可能与 NLRP3 炎症小体相关的炎症有关。
