Kawaguchi Kenichi, Saiwai Hirokazu, Kobayakawa Kazu, Tarukado Kiyoshi, Yokota Kazuya, Matsumoto Yoshihiro, Harimaya Katsumi, Kato Go, Nakashima Yasuharu
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Department of Orthopaedic Surgery, Fukushima Medical University, School of Medicine, Japan.
Spine (Phila Pa 1976). 2025 Aug 15;50(16):1153-1160. doi: 10.1097/BRS.0000000000005178. Epub 2024 Oct 8.
Retrospective study of prospectively collected data.
To investigate the influence of cartilaginous endplates (CEs) in herniated disks on clinical symptoms and postoperative outcomes in patients with lumbar disk herniation (LDH) in different age groups.
LDH involving CEs, which are hard and less resorptive, is frequently observed with increasing age and appears to affect the natural course and clinical outcomes following discectomy.
Overall, 239 patients who underwent microscopic discectomy were included. Main outcomes were evaluated using motor strength, visual analog scale (VAS) for back and leg pain, and Rolland-Morris Disability Questionnaire. The effects of CEs on clinical variables and postoperative outcomes were compared between two groups (below 50 and 50 y or above). Furthermore, we investigated the characteristics of CE avulsions in each group and examined the association between CE occupancy rate and clinical symptoms.
CEs were predominantly observed with increasing age and were more frequently detected in patients with Modic changes in both groups ( P <0.001). A higher proportion of LDH with a ≥20% occupancy rate was found in patients aged below 50 years ( P =0.009) and was associated with a decrease in motor strength preoperatively ( P =0.007). Postoperative VAS score for low back pain (LBP) was higher in patients with CEs than in those without CEs in the 50-year-old or above group ( P <0.001). In multiple regression analysis, the presence of CEs was independently associated with residual LBP at one year postoperatively in older patients (β=0.46, P <0.001).
Avulsion-type herniations in patients aged below 50 years had a higher CE occupancy rate, which is a potential cause of preoperative motor weakness. Clinical outcomes following discectomy improved regardless of the presence of CEs; however, cartilaginous herniation in patients aged 50 years or above may affect residual LBP at one year.
对前瞻性收集的数据进行回顾性研究。
探讨不同年龄组腰椎间盘突出症（LDH）患者中，椎间盘突出伴软骨终板（CEs）对临床症状及术后结果的影响。
随着年龄增长，常可见到涉及坚硬且吸收性较差的CEs的LDH，其似乎会影响椎间盘切除术后的自然病程及临床结果。
共纳入239例行显微椎间盘切除术的患者。主要结局采用肌力、背部和腿部疼痛视觉模拟量表（VAS）以及罗兰-莫里斯残疾问卷进行评估。比较两组（50岁以下和50岁及以上）中CEs对临床变量及术后结果的影响。此外，我们研究了每组中CEs撕脱的特征，并检验了CEs占有率与临床症状之间的关联。
随着年龄增长，CEs更为常见，且在两组中均更常见于存在Modic改变的患者中（P<0.001）。50岁以下患者中，占有率≥20%的LDH比例更高（P=0.009），且与术前肌力下降相关（P=0.007）。在50岁及以上组中，有CEs的患者术后下腰痛（LBP）的VAS评分高于无CEs的患者（P<0.001）。在多元回归分析中，老年患者术后一年CEs的存在与残余LBP独立相关（β=0.46，P<0.001）。
50岁以下患者的撕脱型椎间盘突出症CEs占有率更高，这是术前运动无力的一个潜在原因。无论是否存在CEs，椎间盘切除术后的临床结果均有所改善；然而，50岁及以上患者的软骨性椎间盘突出可能会影响术后一年的残余LBP。
