Department of Anatomy, University of Health Sciences, Lahore, Pakistan.
Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan.
J Orthop Res. 2024 May;42(5):1104-1110. doi: 10.1002/jor.25739. Epub 2023 Nov 29.
Adjacent segment degeneration is commonly observed in patients after fusion surgery. Among the associated risk factors is the preoperative presence of adjacent disc degeneration (ADD). The risk factors and other spine phenotypes associated with preoperative ADD is critical to understand the pathological process and better prognosis postsurgery. Current study aims to assess and compare the magnetic resonance imaging (MRI) spinal phenotype of herniated level with and without ADD. Preoperative T2W sagittal lumbar MRI images of 155 lumbar disc herniated patients were analyzed for the presence of ADD (Pfirrmann grade III and above). The herniated disc level was assessed for the presence and absence of vertebral endplate (VEP) defects, Modic changes, and high intensity zone (HIZ). Mean age of patients was 38 ± 2 years, almost 62% were males. ADD was found in 57%, VEP defects were seen in 62% of the herniated level, 24.5% showed Modic changes, 3.8% showed spondylolishthesis, and 15.5% revealed HIZ. Age and other demographic factors did not have any significant effect on the presence of ADD, the patients with extruded and sequestered discs had more ADD (p = 0.02). VEP defects were significantly higher in levels with ADD (p = 0.02). Patients with ADD had significantly VEP defect scores (p = 0.01), Modic score (p = 0.002), HIZ score (0.02), and posterior bulge score (p < 0.001). Findings suggest that affected levels with VEP defects and severe grade of disc herniation have the greater likelihood of having ADD. Once developed this ADD may also affect the other spinal levels, and also can affect postoperative prognosis.
相邻节段退变在融合手术后的患者中很常见。其中一个相关的危险因素是术前存在相邻椎间盘退变（ADD）。了解与术前 ADD 相关的危险因素和其他脊柱表型对于理解术后病理过程和改善预后至关重要。本研究旨在评估和比较伴有和不伴有 ADD 的突出水平的磁共振成像（MRI）脊柱表型。对 155 例腰椎间盘突出症患者的术前 T2W 矢状位腰椎 MRI 图像进行分析，以确定是否存在 ADD（Pfirrmann 分级 III 及以上）。评估突出椎间盘水平是否存在椎板终板（VEP）缺损、Modic 改变和高信号区（HIZ）。患者的平均年龄为 38±2 岁，近 62%为男性。57%的患者存在 ADD，62%的突出水平存在 VEP 缺损，24.5%的患者出现 Modic 改变，3.8%的患者出现脊椎滑脱，15.5%的患者出现 HIZ。年龄和其他人口统计学因素对 ADD 的存在没有任何显著影响，膨出型和游离型椎间盘的患者 ADD 发生率更高（p=0.02）。ADD 患者的 VEP 缺损评分明显更高（p=0.02）。ADD 患者的 VEP 缺损评分（p=0.01）、Modic 评分（p=0.002）、HIZ 评分（0.02）和后突评分（p<0.001）均明显更高。这些发现表明，伴有 VEP 缺损和严重椎间盘突出的病变水平更有可能发生 ADD。一旦发生这种 ADD，也可能影响其他脊柱水平，并可能影响术后预后。
