Schiopu Dragos, Devriendt Arnaud, Van Vyve Clara, Illes Tamas S
Department of Orthopedics and Traumatology, Brugmann University Hospital Center, Free University of Brussels, Brussels, Belgium.
Department of Medical Imaging, Brugmann University Hospital Center, Free University of Brussels, Brussels, Belgium.
Acta Orthop Traumatol Turc. 2024 Dec 31;58(6):346-357. doi: 10.5152/j.aott.2024.24034.
The aim of this study was to evaluate disc metabolism after decreasing the axial load through surgery by assessing the glycosaminoglycan content through a non-invasive method-delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC).
Sixteen patients with mono-segmental disc degeneration (L4-L5 or L5-S1) who underwent posterior lumbar spine fixation with intervertebral distraction of 2 consecutive vertebrae using monoaxial transpedicular screws and lyophilized allograft to achieve segmental fusion, and who had a follow-up period of at least 2 years, were included in this study. The first lumbar disc was used as the control group. The dGEMRIC studies in degenerative and control discs, visual analogue scale (VAS), Oswestry disability index (ODI), lumbar lordosis, and disc thickness were reviewed before and after surgery.
Visual analogue scale and ODI showed significant improvements (P=.003, P=.0004, respectively). The thickness of the operated discs was increased by an average of 2.41 mm (P=.0004) while maintaining lumbar lordosis (P=.35). In pre- and post-surgery dGEMRIC studies, the operated discs showed a significant di!erence (P=.0013), while the control groups remained approximately unchanged (P=.87).
We have demonstrated that by restoring the disc height and reducing the associated pressure, the glycosaminoglycan content can be increased in the discs, as indicated by a decrease in gadolinium binding. Our results suggest that eliminating pressure on intervertebral discs can prevent their degeneration and initiate the regeneration process.
Level IV, Therapeutic study.
本研究的目的是通过一种非侵入性方法——延迟钆增强磁共振成像（dGEMRIC）评估糖胺聚糖含量，以评价通过手术减轻轴向负荷后的椎间盘代谢情况。
本研究纳入了16例单节段椎间盘退变（L4-L5或L5-S1）患者，这些患者接受了使用单轴椎弓根螺钉和冻干同种异体骨进行连续两个椎体间撑开的后路腰椎固定术以实现节段融合，且随访期至少为2年。将第一腰椎间盘作为对照组。回顾性分析退变椎间盘和对照椎间盘手术前后的dGEMRIC研究、视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、腰椎前凸和椎间盘厚度。
视觉模拟评分和ODI均有显著改善（分别为P = 0.003，P = 0.0004）。手术椎间盘的厚度平均增加了2.41 mm（P = 0.0004），同时维持了腰椎前凸（P = 0.35）。在手术前后的dGEMRIC研究中，手术椎间盘有显著差异（P = 0.0013），而对照组基本保持不变（P = 0.87）。
我们已经证明，通过恢复椎间盘高度并减轻相关压力，椎间盘内的糖胺聚糖含量可以增加，这表现为钆结合减少。我们的结果表明，消除椎间盘上的压力可以防止其退变并启动再生过程。
IV级，治疗性研究。
