Levin Josh, Schirmer Derek, Garcia Roxana, Levi David
Department of Orthopaedic Surgery, Stanford University, 450 Broadway St., Pavilion C, 4 Floor, MC 6342, Redwood City, CA, 94063, USA.
Department of Neurosurgery, Stanford University, USA.
Interv Pain Med. 2023 Mar 16;2(1):100239. doi: 10.1016/j.inpm.2023.100239. eCollection 2023 Mar.
Prior work demonstrated that a history of episodic low back pain was highly indicative of discogenic pain. Recently, there has been more focus on vertebrogenic pain, however little is known about the clinical features of this condition.
To determine if a history of severe episodic low back pain correlates with Modic endplate changes on lumbar spine magnetic resonance imaging (MRI), presumed to be a marker of vertebrogenic pain.
/setting: Retrospective, observational, in vivo study of consecutive patients at outpatient Physical Medicine & Rehabilitation clinics at a single academic spine center.
Consecutive patients who received a lumbar spine MRI between January 1, 2020, and December 31, 2020.
A retrospective chart review identified patients who received a lumbar spine MRI in 2020. Chart review then determined if patients had a history of episodes of low back pain lasting at least 2 days, or if they had non-episodic low back pain (pain beginning with a gradual onset or after a specific event with continuous symptoms for >3 months). Patients were excluded if they had prior lumbar spine surgery, radicular leg pain without low back pain, indeterminate presentations based on chart review, acute spine fractures, or metastatic spine lesions. For the primary analysis, the MRIs were reviewed and were dichotomized into positive (having for either type 1 or type 2 Modic changes at any level) or negative (no Modic changes at any level).
A total of 111 patients were analyzed. Inter-rater reliability for determining whether a patient's low back pain was episodic was strong (kappa = 0.83), as was inter-rater reliability for determining if a patient had any levels with type 1 or type 2 Modic changes (kappa = 0.81). Seventy-one out of 111 patients had type 1 and/or type 2 Modic changes at one or more spinal levels. The sensitivity of the test (episodic vs non-episodic low back pain) in finding patients with Modic changes was 20% and the specificity was 70%. The diagnostic confidence odds were 1.2, with a diagnostic confidence of 55%. Subgroup analyses for type 1 Modic changes, and for type 2 Modic changes, showed similar values.
A history of episodic low back pain is not a strong indicator for a vertebrogenic etiology.
先前的研究表明，发作性腰痛病史高度提示椎间盘源性疼痛。然而，近来对椎体源性疼痛的关注增多，但其临床特征却鲜为人知。
确定严重发作性腰痛病史是否与腰椎磁共振成像（MRI）上的Modic终板改变相关，Modic终板改变被认为是椎体源性疼痛的一个标志。
研究设计/场所：对单个学术性脊柱中心门诊物理医学与康复诊所的连续患者进行回顾性、观察性的体内研究。
2020年1月1日至2020年12月31日期间接受腰椎MRI检查的连续患者。
通过回顾病历确定2020年接受腰椎MRI检查的患者。病历回顾随后确定患者是否有持续至少2天的腰痛发作史，或者是否有非发作性腰痛（疼痛逐渐发作或在特定事件后出现，持续症状超过3个月）。如果患者曾接受过腰椎手术、有腿痛但无腰痛、根据病历回顾表现不明确、有急性脊柱骨折或脊柱转移瘤，则将其排除。对于主要分析，对MRI进行评估并分为阳性（任何节段有1型或2型Modic改变）或阴性（任何节段无Modic改变）。
共分析了111例患者。评估者间确定患者腰痛是否为发作性的可靠性很强（kappa = 0.83），评估者间确定患者是否有任何节段的1型或2型Modic改变的可靠性也很强（kappa = 0.81）。111例患者中有71例在一个或多个脊柱节段有1型和/或2型Modic改变。该测试（发作性与非发作性腰痛）发现有Modic改变患者的敏感性为20%，特异性为70%。诊断置信比为1.2，诊断置信度为55%。对1型Modic改变和2型Modic改变的亚组分析显示了相似的值。
发作性腰痛病史并非椎体源性病因的有力指标。
