Department of Orthopaedics, Xuanwu Hospital Capital Medical University, 100053, Beijing, China.
Department of Stomatology, Xuanwu Hospital Capital Medical University, 100053, Beijing, China.
BMC Surg. 2023 Mar 18;23(1):57. doi: 10.1186/s12893-023-01950-7.
Bacterial microbiome as a putative trigger of inflammation might indicate the cascade of mouth-gut-disc axis for causing intervertebral disc (IVD) structural failures (such as IVD degeneration and endplate change) processed. However, direct evidence for the mouth-gut-disc axis still unclear. Therefore, it is interesting to explore periodontal inflammation related to IVD structural failures and clinical outcomes.
This prospective cohort study enrolled older adults (aged ≥ 75 years) who scheduled to undergo elective open lumbar spine surgery. Demographic, radiological, clinical, and periodontal parameters were recorded. Independent samples t-test and Pearson's correlation analysis were calculated.
A total of 141 patients with lumbar degenerative disorders (56 males and 85 females; age 79.73 ± 3.34 years) were divided into edentulous group (19 patients), No/Mild group (84 patients), and Moderate/Severe group (38 patients). The incidence rates of IVD degeneration in each lumbar segmental level based on Pfirrmann grade and endplate change in the fourth and fifth lumbar vertebrae, and Visual Analogue Scale (VAS) low back pain (LBP) and leg pain of patients at preoperative in dentate group was significantly higher compared with edentulous group, especially the comparisons between Moderate/Severe and edentulous groups. There were no significant differences in the range of motion, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and disc height between dentate and edentulous groups. There was a positive association between plaque index (PLI) and pain scores (VAS LBP: r = 0.215, P = 0.030 and VAS leg pain: r = 0.309, P = 0.005), but no significant difference in Oswestry disability index (ODI) score.
Results show that the severity of periodontitis is associated with higher incidence rates of IVD degeneration and endplate change and clinical outcomes in older adults with lumbar degenerative disorders. Furthermore, the discovery of these relationships unveils a novel mechanism through which the alterations in oral microbiome composition potentially promote IVD degeneration and pain.
细菌微生物组作为炎症的一个潜在触发因素，可能表明口腔-肠道-椎间盘轴在引起椎间盘（IVD）结构退变（如 IVD 退变和终板改变）过程中的级联反应。然而，口腔-肠道-椎间盘轴的直接证据仍不清楚。因此，探索牙周炎与 IVD 结构退变和临床结果的关系很有趣。
本前瞻性队列研究纳入了计划接受择期开放腰椎手术的老年患者（年龄≥75 岁）。记录人口统计学、影像学、临床和牙周参数。计算独立样本 t 检验和 Pearson 相关分析。
共有 141 例腰椎退行性疾病患者（56 名男性和 85 名女性；年龄 79.73±3.34 岁）分为无牙组（19 例）、无/轻度组（84 例）和中/重度组（38 例）。根据 Pfirrmann 分级，在第四和第五腰椎节段的每个腰椎节段水平，以及在术前有牙组患者的椎间盘退变发生率、终板改变和视觉模拟评分（VAS）腰痛（LBP）和腿痛均明显高于无牙组，尤其是中/重度组与无牙组之间的比较。有牙组和无牙组之间的活动范围、腰椎前凸、骨盆入射角、骨盆倾斜角、骶骨斜率和椎间盘高度均无显著差异。菌斑指数（PLI）与疼痛评分（VAS LBP：r=0.215，P=0.030 和 VAS 腿痛：r=0.309，P=0.005）呈正相关，但 Oswestry 残疾指数（ODI）评分无显著差异。
结果表明，牙周炎的严重程度与老年腰椎退行性疾病患者的 IVD 退变和终板改变以及临床结果的发生率较高有关。此外，这些关系的发现揭示了一种新的机制，即口腔微生物组组成的改变可能促进 IVD 退变和疼痛。
