Divi Srikanth N, Goyal Dhruv K C, Makanji Heeren S, Kepler Christopher K, Anderson D Greg, Warner Eric D, Galetta Matthew S, Mujica Victor E, Houlihan Nathan V, Kaye I David, Kurd Mark F, Woods Barrett I, Radcliff Kris E, Rihn Jeffrey A, Hilibrand Alan S, Vaccaro Alexander R, Schroeder Gregory D
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
Int J Spine Surg. 2021 Jun;15(3):458-465. doi: 10.14444/8032. Epub 2021 Apr 1.
Currently, no authors of existing studies have attempted to classify the signal characteristics of disc herniation on magnetic resonance imaging (MRI) and their temporal relationship to symptoms of lumbar radiculopathy. The purpose of this study was to determine whether the MRI signal characteristics are predictive of acuity of symptoms in patients with lumbar disc herniation (LDH).
A retrospective cohort study was conducted on patients treated at an academic center for LDH from 2015 to 2018. Patients were divided into 2 groups based on symptom duration (acute: ≤6 weeks; or chronic: >4 months). Two independent observers measured T1, T2 signal, and other MRI characteristics at the affected disc level. Univariate analysis was used to compare differences between groups. Multiple logistic regression was used to determine predictors of acuity.
Eighty-nine patients were included (33 acute, 56 chronic) with no significant baseline differences between groups. Rater 2 observed a higher proportion of disc bulges in the chronic group ( = .021) and a higher abnormal T1 herniation signal in the acute group ( = .048). Rater 1 found a higher Pfirrmann grade ( = .005) and a higher prevalence of vertebral body spurring ( = .007) in the chronic group. Interobserver agreement for T1 central and herniation signals demonstrated poor to fair agreement, whereas the remainder of the measurements showed moderate to substantial agreement (κ = 0.4-0.8). Multiple logistic regression showed that Pfirrmann Grade 5 (odds ratio = 0.12, 95% confidence interval [0.02, 0.74], = .022) and anterior/posterior spurring (odds ratio = 0.053 [0.03, 0.85], = .023) were not associated with acuity.
Other than Pfirrmann grade or vertebral body spurring, no MRI characteristics could be reliably identified that correlate with acuity of symptoms.
目前，现有研究的作者均未尝试对磁共振成像（MRI）上椎间盘突出的信号特征及其与腰椎神经根病症状的时间关系进行分类。本研究的目的是确定MRI信号特征是否可预测腰椎间盘突出症（LDH）患者症状的严重程度。
对2015年至2018年在某学术中心接受治疗的LDH患者进行回顾性队列研究。根据症状持续时间将患者分为两组（急性：≤6周；或慢性：>4个月）。两名独立观察者在受影响椎间盘水平测量T1、T2信号及其他MRI特征。采用单因素分析比较组间差异。采用多因素logistic回归确定严重程度的预测因素。
纳入89例患者（33例急性，56例慢性），两组间基线无显著差异。观察者2观察到慢性组椎间盘膨出比例较高（P = 0.021），急性组T1突出信号异常较高（P = 0.048）。观察者1发现慢性组Pfirrmann分级较高（P = 0.005），椎体骨刺患病率较高（P = 0.007）。T1中央信号和突出信号的观察者间一致性显示为差至中度一致，而其余测量显示为中度至高度一致（κ = 0.4 - 0.8）。多因素logistic回归显示，Pfirrmann 5级（比值比 = 0.12，95%置信区间[0.02, 0.74]，P = 0.022）和前后骨刺（比值比 = 0.053[0.03, 0.85]，P = 0.023）与严重程度无关。
除Pfirrmann分级或椎体骨刺外，未发现与症状严重程度相关的可靠MRI特征。
3级。
