Liebsch Christian, Wilke Hans-Joachim
Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University Medical Centre, Ulm, Germany.
Institute of Orthopaedic Research and Biomechanics, Trauma Research Centre Ulm, Ulm University Medical Centre, Ulm, Germany.
Spine J. 2025 Jun;25(6):1276-1287. doi: 10.1016/j.spinee.2025.01.024. Epub 2025 Jan 31.
Intradiscal pressure (IDP) is a fundamental parameter for the estimation of loads and muscle forces acting on the spine and a major biomechanical indicator for various spinal pathologies.
To investigate primary effects of intervertebral disc degeneration, age, sex, segmental level, and motion direction on lumbar IDP using a large in vitro data collective.
Evaluation of an internal database comprising 107 human functional spinal units of L2-L3, L3-L4, and L4-L5 from 68 donors (19-74 years, mean 50±12 years, 42% female).
All specimens had been loaded with pure moments of 7.5 Nm in flexion/extension, lateral bending, and axial rotation and IDP had been measured using flexible pressure sensors. Disc degeneration was assessed from radiographs using a validated classification system.
IDP was significantly (p<.05) reduced for degeneration grades 1 (mild degeneration) and 2 (moderate degeneration) compared to grade 0 (no degeneration) in all motion directions and for the intrinsic pressure (INTP) without any loading (moment of 0 Nm). IDP significantly (p<.05) negatively (-0.69≤r≤-0.45) correlated with age and was significantly (p<.05) reduced for an age >40 years in all motion directions and for the INTP. Sex did not significantly (p<.05) affect the IDP. The IDP at L4-L5 level was significantly (p<.05) reduced compared to the IDP at L2-L3 level in all motion directions and for the INTP and significantly (p<.05) lower in axial rotation and for the INTP compared to flexion/extension and lateral bending.
This study revealed that more degenerated discs and discs from elderly donors exhibit low or even negative intradiscal pressure, overall questioning in vitro and in vivo IDP measurements which disregard the degenerative condition of the intervertebral discs and the age of the donors and participants.
Increasing disc degeneration and age as well as more distal lumbar level are associated with decreased IDP of the lumbar spine, possibly less maintaining the load sharing capacity and thus representing risk factors for spinal pathologies.
椎间盘内压力（IDP）是评估作用于脊柱的负荷和肌肉力量的一个基本参数，也是各种脊柱病变的主要生物力学指标。
利用大量体外数据，研究椎间盘退变、年龄、性别、节段水平和运动方向对腰椎IDP的主要影响。
评估一个内部数据库，该数据库包含来自68名捐赠者（年龄19 - 74岁，平均50±12岁，42%为女性）的107个L2 - L3、L3 - L4和L4 - L5节段的人体功能性脊柱单元。
所有标本在屈伸、侧屈和轴向旋转时均施加7.5 Nm的纯力矩，并使用柔性压力传感器测量IDP。使用经过验证的分类系统从X线片评估椎间盘退变情况。
与0级（无退变）相比，在所有运动方向以及无任何负荷（力矩为0 Nm）时的固有压力（INTP）下，1级（轻度退变）和2级（中度退变）椎间盘的IDP显著降低（p <.05）。IDP与年龄显著负相关（p <.05，-0.69≤r≤-0.45），在所有运动方向以及INTP方面，年龄>40岁时IDP显著降低（p <.05）。性别对IDP无显著影响（p <.05）。在所有运动方向以及INTP方面，L4 - L5节段的IDP与L2 - L3节段相比显著降低（p <.05），并且在轴向旋转以及INTP方面，与屈伸和侧屈相比显著更低（p <.05）。
本研究表明，退变程度更高的椎间盘以及老年捐赠者的椎间盘呈现出低的甚至是负的椎间盘内压力，总体上对忽略椎间盘退变状况以及捐赠者和参与者年龄的体外和体内IDP测量提出质疑。
椎间盘退变加剧、年龄增加以及腰椎更靠下的节段与腰椎IDP降低相关，这可能会降低负荷分担能力，因此是脊柱病变的危险因素。
