Li Yongchao, Su Qihang, Feng Xiaofei, Li Lijun, Tan Jun, Ke Rongjun
Department of Orthopedics, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China.
Department of Orthopedics, The Third Medical Center of Chinese PLA General Hospital, Beijing, China.
Front Surg. 2023 Jan 10;9:1091717. doi: 10.3389/fsurg.2022.1091717. eCollection 2022.
Whether vertebral augmentation can induce or aggravate the degeneration of adjacent intervertebral discs remains controversial. The purpose of this study is to explore the role of endplate injury in intervertebral disc degeneration after vertebral augmentation.
The imaging data of patients with single-segment osteoporotic vertebral compression fractures (OVCFs) were retrospectively analyzed. The upper and lower discs of the fractured vertebrae were defined as cranial and caudal discs, and the discs adjacent to the cranial discs were defined as control discs. According to the integrity of the cranial and caudal endplates, they were divided into an injury group and a noninjury group. At follow-up, the increase in the modified Pfirrmann score on MRI compared with the baseline grade was defined as the occurrence of a degenerative disc change (DDC). The changes in the disc height and the number of DDC cases on MRI during the follow-up in each group were analyzed.
A total of 56 patients with OVCFs were included in this study, with an average follow-up time of 18.8 ± 14.1 months (3-62 months). In the cranial and caudal discs, the number of DDC cases in the endplate injury group was significantly higher than that in the noninjury group ( = 0.007 and = 0.018). However, the number of DDC cases in the whole endplate injury group (including the cranial and caudal endplates) was significantly higher than that of the whole noninjury group ( = 0.000) and the control group ( = 0.000). The number of DDC cases in the whole noninjury group was not different from that of the control group ( = 0.192). At follow-up, the disc height of the cranial and caudal endplate injury group was significantly lower than the baseline ( = 0.000 and = 0.001), but the disc height of the noninjury group was not significantly lower than the baseline ( = 0.074 and = 0.082).
Endplate injury is associated with adjacent intervertebral disc degeneration in OVCF patients after vertebral augmentation. Evaluation of endplate damage before vertebral enhancement in OVCF patients has an important reference value for predicting the outcome of adjacent intervertebral discs after surgery.
椎体强化术是否会诱发或加重相邻椎间盘退变仍存在争议。本研究旨在探讨终板损伤在椎体强化术后椎间盘退变中的作用。
回顾性分析单节段骨质疏松性椎体压缩骨折（OVCF）患者的影像学资料。将骨折椎体的上位和下位椎间盘定义为头侧和尾侧椎间盘，将与头侧椎间盘相邻的椎间盘定义为对照椎间盘。根据头侧和尾侧终板的完整性，将其分为损伤组和非损伤组。随访时，将MRI上改良Pfirrmann评分较基线等级的增加定义为椎间盘退变改变（DDC）的发生。分析每组随访期间MRI上椎间盘高度的变化及DDC病例数。
本研究共纳入56例OVCF患者，平均随访时间为18.8±14.1个月（3 - 62个月）。在头侧和尾侧椎间盘中，终板损伤组的DDC病例数显著高于非损伤组（=0.007和=0.018）。然而，整个终板损伤组（包括头侧和尾侧终板）的DDC病例数显著高于整个非损伤组（=0.000）和对照组（=0.000）。整个非损伤组的DDC病例数与对照组无差异（=0.192）。随访时，头侧和尾侧终板损伤组的椎间盘高度显著低于基线（=0.000和=0.001），而非损伤组的椎间盘高度与基线相比无显著降低（=0.074和=0.082）。
终板损伤与OVCF患者椎体强化术后相邻椎间盘退变相关。评估OVCF患者椎体强化术前的终板损伤情况对预测术后相邻椎间盘的转归具有重要参考价值。
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