Tsuchiya Koki, Okano Ichiro, Guven Ali E, Verna Bruno, Köhli Paul, Hambrecht Jan, Evangelisti Gisberto, Chiapparelli Erika, Burkhard Marco D, Tripathi Vidushi, Shue Jennifer, Girardi Federico P, Cammisa Frank P, Sama Andrew A, Hughes Alexander P
Spine Care Institute, Hospital for Special Surgery, New York, NY, USA; Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
Department of Orthopaedic Surgery, Showa University School of Medicine, Tokyo, Japan.
Spine J. 2025 May;25(5):903-910. doi: 10.1016/j.spinee.2024.11.017. Epub 2024 Dec 5.
BACKGROUND/CONTEXT: The assessment of disc degeneration remains a significant challenge in clinical research. Pfirrmann grade is a frequently used classification for lumbar disc degeneration on MRI. However, there has been no gold standard for cervical spine disc degeneration. Recently, we introduced the Disc Signal Intensity Index (DSI2) as a quantitative disc assessment for the lumbar spine, which is easily measurable in the cervical spine.
The aim of this study was to apply DSI2 in the cervical intervertebral disc and investigate the factors associated with the cervical disc degeneration.
STUDY DESIGN/SETTING: Cross-sectional study using retrospectively collected data.
Cervical MRIs from a database of patients undergoing ACDF between 2015 and 2018 were retrospectively reviewed.
Demographic variables included age, sex, body mass index (BMI), race, smoking status, and comorbidities such as diabetes, chronic kidney disease, and coronary artery disease.
DSI2 measurements were performed on midsagittal T2-weighted MRI images by determining the intensity within regions of interest (ROI). One ROI was set in the cerebrospinal fluid (CSF) and three ROIs were set per disc at the anterior, middle, and posterior third. The mean of the three measurements per disc was then divided by that of the CSF to calculate the DSI2 score. Multivariable linear regression analyses with mixed model were conducted to determine the potential contributing factors for disc degeneration.
A total of 149 patients and 770 discs were included in the final analysis. Ninety-three patients (37.6%) were female and the mean (SD) age was 55.6 (11.7) years. The distribution of DSI2 scores among the different Pfirrmann grades was as follows: Grade 1: 0.259±NA; Grade 2: 0.226±0.090; Grade 3: 0.175±0.070; Grade 4: 0.136±0.060; Grade 5: 0.131±0.050. Multivariable linear mixed-effect regression analysis, setting with DSI2 as the objective variable, demonstrated that age (β=-0.130, p<.05), BMI (β=-2.06, p<.05), Modic changes (Type1 β= -2.70, p<.01) were independent contributors to disc degeneration. The segments C4/5 and C7/T1 were less prone to disc degeneration (C4/5: β=1.37, p<.001; C7/T1: β=2.63, p<.001) and the history of diabetes (β=5.31, p<.01) was associated with high DSI2.(p<.01).
The present study provides valuable insights for identifying risk factors in degenerative cervical conditions utilizing the DSI2. The DSI2 method emerges as a promising alternative for future disc research, excelling in the detection of subtle progressions of degeneration and distinguishing itself from the subjective Pfirrmann grading system.
背景/环境：椎间盘退变的评估仍是临床研究中的一项重大挑战。Pfirrmann分级是MRI上常用于腰椎间盘退变的分类方法。然而，颈椎间盘退变尚无金标准。最近，我们引入了椎间盘信号强度指数（DSI2）作为腰椎间盘的定量评估指标，该指标在颈椎中也易于测量。
本研究旨在将DSI2应用于颈椎间盘，并探讨与颈椎间盘退变相关的因素。
研究设计/设置：采用回顾性收集数据的横断面研究。
回顾性分析2015年至2018年间接受ACDF手术患者数据库中的颈椎MRI。
人口统计学变量包括年龄、性别、体重指数（BMI）、种族、吸烟状况以及糖尿病、慢性肾病和冠状动脉疾病等合并症。
在矢状面T2加权MRI图像上通过确定感兴趣区域（ROI）内的强度来进行DSI2测量。在脑脊液（CSF）中设置一个ROI，每个椎间盘在前、中、后三分之一处各设置三个ROI。然后将每个椎间盘三次测量的平均值除以CSF的平均值来计算DSI2评分。进行多变量线性回归分析和混合模型分析以确定椎间盘退变的潜在影响因素。
最终分析纳入了149例患者和770个椎间盘。93例（37.6%）为女性，平均（标准差）年龄为55.6（11.7）岁。不同Pfirrmann分级的DSI2评分分布如下：1级：0.259±无数据；2级：0.226±0.090；3级：0.175±0.070；4级：0.136±0.060；5级：0.131±0.050。以DSI2为目标变量的多变量线性混合效应回归分析表明，年龄（β=-0.130，p<0.05）、BMI（β=-2.06,p<0.05）、Modic改变（1型β=-2.70,p<0.01）是椎间盘退变的独立影响因素。C4/5和C7/T1节段不易发生椎间盘退变（C4/5：β=1.37，p<0.001；C7/T1：β=2.63，p<0.001），糖尿病史（β=5.31，p<0.01）与高DSI2相关（p<0.01）。
本研究为利用DSI2识别退行性颈椎疾病的危险因素提供了有价值的见解。DSI2方法成为未来椎间盘研究的一种有前景的替代方法，在检测退变的细微进展方面表现出色，且有别于主观的Pfirrmann分级系统。
