Li Wensen, Djuric Niek, Mink Christiaan, Vleggeert-Lankamp Carmen L A
Neurosurgical Center Holland, Leiden University Medical Center & Haaglanden Medical Center & Haga Teaching Hospital, Hoofddorp, Haarlem, the Netherlands.
Spaarne Gasthuis, Hoofddorp, Haarlem, the Netherlands.
Brain Spine. 2025 Mar 26;5:104249. doi: 10.1016/j.bas.2025.104249. eCollection 2025.
Lumbar disc herniation (LDH) typically manifests as sciatica, attributed to nerve root mechanical compression and/or inflammation. Modic changes (MC), classified as type I or type II, are deemed to represent endplate vascular insufficiency and are hypothesized to create an inflammatory environment. Macrophages infiltrating disc tissue can be polarized into pro-inflammatory M1 or anti-inflammatory M2 phenotypes.
This study aims to investigate the interplay among inflammatory cells, including M1 and M2 macrophages, Modic Changes, and hernia size and type in patients suffering from sciatica due to a LDH.
This prospective cohort study selected patients undergoing microdiscectomy for LDH. Macrophage infiltration (CD68, CD192, CD163), MC classification on MRI, and hernia parameters were analyzed.
132 out of 187 patients demonstrated macrophages in the lumbar disc tissue. Most samples demonstrated severe inflammation (50 %), and most macrophages were of the M1 phenotype (48 %). MC were present in 45 % of patients, and only 19 % of these demonstrated MC type I. MC type I were highly associated with both severe (p = 0.016) and M1 macrophage-dominant inflammation (p = 0.048). Larger and non-contained herniations associated with increased inflammation (p = 0.029/p = 0.002), while larger herniations associated with the presence of MC type II (p = 0.027).
This study elucidates a close association of MC type I and M1 macrophage. MC type II were observed more often in patients with larger HNPs. This is indicative for MC typing as an important factor in prediction modelling and it suggests the potential for personalized treatment strategies.
腰椎间盘突出症（LDH）通常表现为坐骨神经痛，这归因于神经根的机械性压迫和/或炎症。Modic改变（MC）分为I型或II型，被认为代表终板血管功能不全，并被假定会产生炎症环境。浸润椎间盘组织的巨噬细胞可极化为促炎性M1或抗炎性M2表型。
本研究旨在调查因LDH导致坐骨神经痛的患者中，包括M1和M2巨噬细胞在内的炎症细胞、Modic改变以及突出大小和类型之间的相互作用。
这项前瞻性队列研究选取了接受LDH显微椎间盘切除术的患者。分析了巨噬细胞浸润情况（CD68、CD192、CD163）、MRI上的MC分类以及突出参数。
187例患者中有132例在腰椎间盘组织中发现了巨噬细胞。大多数样本显示出严重炎症（50%），且大多数巨噬细胞为M1表型（48%）。45%的患者存在MC，其中仅19%表现为I型MC。I型MC与严重炎症（p = 0.016）和以M1巨噬细胞为主的炎症均高度相关（p = 0.048）。较大且非包容性的突出与炎症增加相关（p = 0.029/p = 0.002），而较大的突出与II型MC的存在相关（p = 0.027）。
本研究阐明了I型MC与M1巨噬细胞之间的密切关联。在较大的腰椎间盘突出症患者中更常观察到II型MC。这表明MC分型是预测模型中的一个重要因素，并提示了个性化治疗策略的可能性。
