Chen Jia-Yu, Yang Jia-Chen, Li Ruo-Yao, Huang Zu-Cheng, Huang Zhi-Ping, Wu Xiu-Hua, Zhu Qing-An, Ding Yin
Department of Spinal Surgery, The First People's Hospital of Chenzhou, Chenzhou, China.
Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Orthop Surg. 2025 Feb;17(2):460-469. doi: 10.1111/os.14310. Epub 2024 Dec 4.
The relationship between cervical disc degeneration and bone quality of adjacent vertebral body remains controversial. This study aims to investigate the relationship between cervical disc degeneration and bone quality of the adjacent vertebral body and sub-endplate bone with a new MRI-based bone quality score in patients over 50 years with cervical spondylosis.
We retrospectively reviewed 479 cervical disc segments from 131 patients. Disc degeneration at levels C3/C4-C6/C7 was graded using T2-weighted MRI. Vertebral body quality (VBQ) score and sub-endplate bone quality (EBQ) score from C3 to C7 were computed from T1-weighted MRI images. Additionally, bone mineral density (BMD) of the cervical vertebrae was measured in 52 patients using a novel phantom-less quantitative computed tomography (PL-QCT) system. The correlation between bone quality score and Pfirrmann grade was analyzed and risk factors for VBQ and EBQ were further evaluated.
Significant differences were found in cranial VBQ among different Pfirrmann grades, with a score of 2.55 ± 0.54 for Grade 5 discs, which was lower compared to Grades 4 (2.70 ± 0.56) (p < 0.05) and 3 (2.81 ± 0.58) (p < 0.01). Caudal VBQ for Grade 5 discs (2.43 ± 0.52) was also significantly lower than for Grade 3 discs (2.66 ± 0.54) (p < 0.01). EBQ scores decreased with increasing Pfirrmann grades. Negative correlations were observed between both cranial and caudal VBQ and EBQ scores and Pfirrmann grades. Grades 4 and 5 discs were identified as independent risk factors for decreased caudal VBQ and EBQ, whereas only Grade 5 was a significant risk factor for decreased cranial EBQ. Additionally, a moderate correlation (0.4 < R < 0.6, p < 0.05) was noted between vertebral body BMD and VBQ at each cervical level.
In individuals over 50 years with cervical spondylosis, the severity of disc degeneration was closely correlated with denser bone quality in both the caudal vertebral body and sub-endplate, as measured by VBQ and EBQ scores. These findings suggest that worsening disc degeneration is associated with increased bone density in specific areas of the cervical spine.
颈椎间盘退变与相邻椎体骨质之间的关系仍存在争议。本研究旨在通过一种基于磁共振成像（MRI）的新骨质评分系统，调查50岁以上颈椎病患者颈椎间盘退变与相邻椎体及终板下骨质之间的关系。
我们回顾性分析了131例患者的479个颈椎间盘节段。采用T2加权MRI对C3/C4至C6/C7节段的椎间盘退变进行分级。根据T1加权MRI图像计算C3至C7椎体质量（VBQ）评分和终板下骨质质量（EBQ）评分。此外，使用新型无体模定量计算机断层扫描（PL-QCT）系统对52例患者的颈椎骨密度（BMD）进行了测量。分析骨质评分与Pfirrmann分级之间的相关性，并进一步评估VBQ和EBQ的危险因素。
不同Pfirrmann分级之间的上位VBQ存在显著差异，5级椎间盘评分为2.55±0.54，低于4级（2.70±0.56）（p<0.05）和3级（2.81±0.58）（p<0.01）。5级椎间盘的下位VBQ（2.43±0.52）也显著低于3级椎间盘（2.66±0.54）（p<0.01）。EBQ评分随Pfirrmann分级增加而降低。上位和下位VBQ及EBQ评分与Pfirrmann分级之间均存在负相关。4级和5级椎间盘被确定为下位VBQ和EBQ降低的独立危险因素，而只有5级是上位EBQ降低的显著危险因素。此外，每个颈椎节段的椎体BMD与VBQ之间存在中度相关性（0.4<R<0.6，p<0.05）。
在50岁以上的颈椎病患者中，通过VBQ和EBQ评分测量，椎间盘退变的严重程度与下位椎体及终板下更致密的骨质质量密切相关。这些发现表明，椎间盘退变加重与颈椎特定区域的骨密度增加有关。
