Suri Pradeep, Elgaeva Elizaveta, Jarvik Jeffrey, Rundell Sean, Tsepilov Yakov, Williams Frances, Heagerty Patrick
University of Washington, Seattle, USA.
VA Puget Sound Health Care System, Seattle, USA.
Eur Spine J. 2025 Jun 10. doi: 10.1007/s00586-025-08976-w.
To examine associations between lumbar intervertebral disc degeneration (LDD) and type II Modic changes (MC) when retaining information at each interspace ("interspace-level analysis"), as compared to aggregating information across interspaces as is typically done in spine research ("person-level analysis"). The study compared results from (1) interspace-level analyses assuming a common relationship across interspaces (the "interspace-level, common-relationship" approach), (2) interspace-level analyses allowing for interspace-specific associations (an "interspace-level, interspace-specific" approach), (3) and a conventional person-level analytic approach.
Adults in primary care (n = 147) received lumbar spine magnetic resonance imaging and neuroradiologist-evaluated assessments of prevalent disc height narrowing (DHN), type II MC, and other LDD parameters. Analyses examined associations between DHN and type II MC in interspace-level, common-relationship analyses, interspace-level, interspace-specific analyses, and conventional person-level analyses.
Cross-sectional, interspace-level, common-relationship analyses found large-magnitude DHN-type II MC associations (adjusted OR [aOR] = 6.5, 95% confidence intervals (CIs) 3.3-13; p < 0.001). The magnitude of this association was larger and more precise than that yielded by person-level analyses (aOR = 2.9 [95% CI 1.2-7]), and substantially more precise than interspace-level, interspace-specific analyses which allowed the association between DHN and type II MC to vary across levels. Across exploratory analyses of disc signal intensity and other MC types, interspace-level, common-relationship analyses produced larger-magnitude and more precise associations than person-level analyses in most situations, and were more precise than interspace-level, interspace-specific analyses.
Interspace-level analytic approaches offer some advantages to person-level analyses that may be useful in understanding relationships between spinal degeneration findings.
与脊柱研究中通常采用的跨间隙汇总信息的方法（“个体水平分析”）相比，在保留每个间隙信息的情况下（“间隙水平分析”），研究腰椎间盘退变（LDD）与II型Modic改变（MC）之间的关联。本研究比较了以下三种分析方法的结果：（1）假设各间隙存在共同关系的间隙水平分析（“间隙水平，共同关系”方法）；（2）允许间隙特异性关联的间隙水平分析（“间隙水平，间隙特异性”方法）；（3）传统的个体水平分析方法。
初级保健机构中的成年人（n = 147）接受了腰椎磁共振成像检查，并由神经放射科医生对普遍存在的椎间盘高度狭窄（DHN）、II型MC及其他LDD参数进行评估。分析在间隙水平、共同关系分析、间隙水平、间隙特异性分析以及传统的个体水平分析中，研究DHN与II型MC之间的关联。
横断面间隙水平共同关系分析发现，DHN与II型MC之间存在强关联（调整后比值比[aOR] = 6.5，95%置信区间[CI] 3.3 - 13；p < 0.001）。该关联的强度大于个体水平分析得出的结果（aOR = 2.9 [95% CI 1.2 - 7]），且比允许DHN与II型MC之间的关联在各间隙水平有所不同的间隙水平间隙特异性分析更为精确。在对椎间盘信号强度和其他MC类型的探索性分析中，间隙水平共同关系分析在大多数情况下产生的关联强度更大且更精确，比个体水平分析更精确，也比间隙水平间隙特异性分析更精确。
间隙水平分析方法相对于个体水平分析具有一些优势，这可能有助于理解脊柱退变结果之间的关系。
