Schiopu Dragos, Devriendt Arnaud, Reynders Piet, Illés S Tamás
1 Service d'Orthopédie et Traumatologie, Centre Hospitalier Universitaire - Brugmann, Université Libre de Bruxelles Place Van Gehuchten 4., Bruxelles 1020 Belgique.
2 Département d'Imagerie Médicale, Centre Hospitalier Universitaire - Brugmann, Université Libre de Bruxelles Bruxelles Belgique.
Orv Hetil. 2022 May 15;163(20):789-796. doi: 10.1556/650.2022.32462.
Introduction: Segmental instability of the spine caused by the decreased height of intervertebral discs is one of the major causes of chronic low back pain affecting 70-80% of the adult population. The decrease in height is due to degenerative lesions induced by vertical compression overload of the disc. Objective: A preliminary study was performed to determine if disc degeneration due to overload could be stopped. We hypothesized that disc distraction during fission surgery from posterior approach could reduce the pressure on the discs, degeneration could be stopped, and perhaps the function could be restored. Methods: To characterize the condition of the discus, we used the determination glycosaminoglycan content, which is responsible for the disc-bound water content and thus for ensuring its elasticity. The use of gadolinium contrast agent in MRI (dGEMRIC) is an accepted method for determining the glycosaminoglycan content of the intervertebral disc, as the concentration of absorbed contrast agent is inversely proportional to the number of glycosaminoglycans in the intervertebral discs. In addition to pre- and postoperative dGEMRIC data, we examined disc height, lumbar lordosis, visual analog pain scale, and the Oswestry Disability Index. Results: All patients underwent monosegmental fusion Mowing posterior distraction of the affected segment due to segmental instability. During the surgeries, lumbar lordosis did not decrease despite posterior distraction. The heights of the discus increased by an average of 3 mm, the pain decreased, and the Oswestry Disability Index improved. In the dGEMRIC studies, an average of 309.18 units/cm(2) of gadolinium accumulated in the discs before surgery, which decreased postoperatively to 174.43 units/cm(2). All changes were significant at the p = 0.05 significance level. Conclusion: The trend of our preliminary results suggests that increasing the height of the discs can reduce the hydrostatic pressure in the discs, resulting in an increase in the amount of glycosaminoglycans, which can stop the degeneration of the discs and also initiate regeneration processes.
椎间盘高度降低导致的脊柱节段性不稳定是慢性下腰痛的主要原因之一，影响着70%至80%的成年人群。高度降低是由于椎间盘垂直压缩过载引起的退行性病变所致。目的：进行一项初步研究，以确定因过载导致的椎间盘退变是否可以停止。我们假设后路裂核手术中的椎间盘撑开可以减轻椎间盘压力，阻止退变，甚至恢复功能。方法：为了表征椎间盘状况，我们采用测定糖胺聚糖含量的方法，糖胺聚糖负责椎间盘的结合水含量，从而确保其弹性。在磁共振成像（MRI）中使用钆对比剂（dGEMRIC）是一种确定椎间盘糖胺聚糖含量的公认方法，因为吸收的对比剂浓度与椎间盘中糖胺聚糖的数量成反比。除了术前和术后的dGEMRIC数据外，我们还检查了椎间盘高度、腰椎前凸、视觉模拟疼痛量表和奥斯维斯特残疾指数。结果：所有患者均因节段性不稳定接受了受累节段后路撑开后的单节段融合手术。手术过程中，尽管进行了后路撑开，腰椎前凸并未降低。椎间盘高度平均增加了3毫米，疼痛减轻，奥斯维斯特残疾指数有所改善。在dGEMRIC研究中，术前椎间盘平均积累了309.18单位/平方厘米的钆，术后降至174.43单位/平方厘米。所有变化在p = 0.05的显著性水平上均具有统计学意义。结论：我们初步结果的趋势表明，增加椎间盘高度可以降低椎间盘内的静水压力，导致糖胺聚糖数量增加，从而可以阻止椎间盘退变并启动再生过程。
