磁共振成像上的Modic改变和吸烟史可预测腰椎前路暴露期间的血管粘连。
Modic Changes on Magnetic Resonance Imaging and Smoking History Predict Vascular Adherence During Anterior Lumbar Exposure.
作者信息
Malham Gregory M, Johnson Nicholas, Claydon Matthew H
机构信息
Neuroscience Institute, Epworth Hospital, Melbourne, Australia
Department of Vascular Surgery, The Alfred, Melbourne, Australia.
出版信息
Int J Spine Surg. 2021 Dec;15(6):1054-1059. doi: 10.14444/8190.
BACKGROUND
Anterior approaches to surgically access the lumbar intervertebral discs are associated with a risk of developing major vascular injury and bleeding. The likelihood of injury increases in the presence of dense adherence between the disc annulus, vertebral periosteum, and vessels, which result from reactive inflammatory changes that cause fibrous scarring.
OBJECTIVE
To identify factors that predict vascular adherence, which may facilitate preoperative planning and technique modifications for anterior spine surgery.
STUDY DESIGN
Prospective study examining patients undergoing anterior retroperitoneal exposure for lumbar disc surgery.
METHODS
A total of 246 consecutive patients were enrolled in this study, all of whom had anterior retroperitoneal exposure for lumbar disc surgery. Patient demographics, smoking status, magnetic resonance imaging (MRI) findings, operative parameters, and dissection difficulty associated with vascular adherence were recorded. Current smokers were defined as those who smoked at the time of surgery or had ceased smoking <6 months before the operation. Patients were excluded if they were morbidly obese or had previously undergone anterior spine surgery or radiotherapy.
RESULTS
A multivariate regression analysis identified 2 significant risk factors for difficult dissections that are complicated by vascular adhesion: Modic Type 2 changes on MRI ( = 0.009) and any history of smoking ( = 0.007). Patients with Modic Type 2 changes or a smoking history were 2.1 and 2.2 times more likely to present with vascular adherence, respectively.
CONCLUSIONS
Modic Type 2 changes on MRI and any smoking history can predict the adherence of large blood vessels to the anterior disc annulus, which enhances the difficulty of the dissection. These predictors could indicate to spinal surgeons that the patient has a 2-fold increased risk of vascular adherence.
CLINICAL RELEVANCE
Modic Type 2 changes on MRI and any smoking history can predict the adherence of large blood vessels to the anterior disc annulus, which enhances the difficulty of the dissection. These predictors could indicate to spinal surgeons that the patient has a 2-fold increased risk of vascular adherence during anterior lumbar exposure.
LEVEL OF EVIDENCE
背景
通过前路手术进入腰椎间盘存在发生重大血管损伤和出血的风险。椎间盘纤维环、椎体骨膜和血管之间因反应性炎症变化导致纤维瘢痕形成而出现致密粘连时，损伤的可能性会增加。
目的
确定预测血管粘连的因素，这可能有助于前路脊柱手术的术前规划和技术改进。
研究设计
对接受前路腹膜后暴露腰椎间盘手术的患者进行前瞻性研究。
方法
本研究共纳入246例连续患者，均接受了前路腹膜后暴露腰椎间盘手术。记录患者的人口统计学资料、吸烟状况、磁共振成像（MRI）结果、手术参数以及与血管粘连相关的解剖难度。当前吸烟者定义为手术时吸烟或术前<6个月戒烟者。病态肥胖、既往接受过前路脊柱手术或放疗的患者被排除。
结果
多因素回归分析确定了2个导致伴有血管粘连的复杂解剖困难的显著危险因素：MRI上的Modic 2型改变（P = 0.009）和任何吸烟史（P = 0.007）。有Modic 2型改变或吸烟史的患者出现血管粘连的可能性分别是其他患者的2.1倍和2.2倍。
结论
MRI上的Modic 2型改变和任何吸烟史可预测大血管与椎间盘前纤维环的粘连，这会增加解剖难度。这些预测因素可提示脊柱外科医生患者发生血管粘连的风险增加了2倍。
临床意义
MRI上的Modic 2型改变和任何吸烟史可预测大血管与椎间盘前纤维环的粘连，这会增加解剖难度。这些预测因素可提示脊柱外科医生在腰椎前路暴露期间患者发生血管粘连的风险增加了2倍。
证据水平
3级。
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