Department of Imaging and Interventional Radiology, Faculty of Medicine, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong SAR.
BMC Musculoskelet Disord. 2022 Jul 10;23(1):655. doi: 10.1186/s12891-022-05561-w.
Our previous studies found disproportionate anteroposterior vertebral size is associated with severity of the scoliotic curves in adolescent idiopathic scoliosis (AIS) patients. Subsequent studies showed wedging of vertebral bodies (VB) had less contribution than intervertebral discs (IVD) to the anterior-posterior vertebral column length discrepancy in severe-AIS. However, the exact morphological changes of IVD were not clearly defined. This study aimed to evaluate the morphological and pathological changes of IVD and VB in AIS girls and healthy female controls.
This study included 33 age-matched female controls and 76 AIS girls with a right-sided thoracic curvature. Wedge angle, height ratio and distance ratio of VB and IVD were measured on the best midline coronal and sagittal planes from reformatted MRI spine. Volumes of VB, IVD and nucleus pulposus (NP) were also evaluated on volumetric images. One-way ANOVA with Bonferroni correction and Pearson correlation tests were used.
There was significant difference in wedge angle and height ratio of VB and IVD between AIS and controls. In severe-AIS, the position of NP was significantly shifted to the convexity when compared with non-severe AIS and controls. Whereas, the volume of IVD and NP in severe-AIS was found to be significantly smaller. In addition, Cobb angle was significantly correlated with wedge angle and height ratio, and inversely correlated with the volume of NP.
In addition to wedging of VB and IVD, there was significantly reduced volume of IVD and NP in AIS patients with severe curve, insinuating the mechanical effect of scoliosis leads to a compression on both IVD and NP before significant disc desiccation occurs. We postulate that the compression of IVD and NP can contribute to curve progression in severe-AIS, these patients are more prone to disc degeneration in adulthood if no operative treatment is offered. Further longitudinal study on these parameters is still warranted.
我们之前的研究发现，在青少年特发性脊柱侧凸（AIS）患者中，前后椎体大小不成比例与脊柱侧凸曲度的严重程度相关。随后的研究表明，椎体楔形（VB）的楔入对重度 AIS 中前后脊柱长度差异的贡献小于椎间盘（IVD）。然而，IVD 的确切形态变化尚未明确界定。本研究旨在评估 AIS 女孩和健康女性对照组中 IVD 和 VB 的形态和病理变化。
本研究纳入了 33 名年龄匹配的女性对照组和 76 名右侧胸弯 AIS 女孩。在 MRI 脊柱矢状位和冠状位最佳中线上测量 VB 和 IVD 的楔形角、高度比和距离比。还在容积图像上评估 VB、IVD 和髓核（NP）的体积。采用单因素方差分析（ANOVA）和 Bonferroni 校正以及 Pearson 相关检验。
AIS 组与对照组之间 VB 和 IVD 的楔形角和高度比存在显著差异。在重度 AIS 中，NP 的位置明显向凸侧移位，与非重度 AIS 和对照组相比。而重度 AIS 中 IVD 和 NP 的体积明显较小。此外，Cobb 角与楔形角和高度比呈显著正相关，与 NP 体积呈显著负相关。
除了 VB 和 IVD 的楔形外，严重曲度 AIS 患者的 IVD 和 NP 体积明显减小，表明脊柱侧凸的机械效应在椎间盘明显干燥之前对 IVD 和 NP 产生压迫。我们推测，IVD 和 NP 的压缩可能会导致重度 AIS 中的曲线进展，如果不进行手术治疗，这些患者在成年后更容易发生椎间盘退变。仍需要对这些参数进行进一步的纵向研究。
