Leonova Olga, Elgaeva Elizaveta, Berdnikova Anna, Tsepilov Yakov, Krutko Aleksandr
Priorov National Medical Research Center of Traumatology and Orthopedics, Moscow, Russia.
Institute of Cytology and Genetics of the Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia.
Global Spine J. 2025 Sep 3:21925682251373046. doi: 10.1177/21925682251373046.
Study DesignProspective disease-oriented study.ObjectiveTo describe the MRI findings in patients with failed conservative treatment for degenerative lumbar diseases and to identify predictors of back pain intensity in these patients.MethodsWe analyzed demographic (sex, age) and clinical scale data as well as the lumbar MRI findings (Pfirrmann disc degeneration, Modic types, endplate defects, disc height and osteophytes) in RuDDS patients. We examined the prevalence of degenerative changes in different age groups and searched for predictors of back pain intensity after the procedure in patients with specific leading syndromes.ResultsPatients with failed conservative treatment demonstrate more severe degeneration of the discs and endplates, more Modic changes, and higher Jarosz scores than reported in population-based studies. Individuals with degenerative stenosis have the most severe lumbar spine degeneration compared to patients with other leading syndromes (facet joint pain, lumbar disc herniation, degenerative deformity) ( < 0.004). Lumbar MRI findings had a weak (β < 0.1) though statistically significant effect on back pain intensity before the procedure and clinically significant back pain attenuation after it. Smoking had a greater impact on back pain and its attenuation after the procedure, especially in patients with degenerative stenosis (β = 0.307 and OR = 2.03, respectively).ConclusionThis is the first characterization of MRI findings in patients with failed conservative treatment. Smokers show more prominent back pain attenuation after the procedure than non-smokers; however it is not clear whether this treatment effect is sufficient.The trial registry number is NCT04600544 on clinicaltrials.gov.
研究设计
前瞻性疾病导向性研究。
目的
描述退行性腰椎疾病保守治疗失败患者的MRI表现，并确定这些患者背痛强度的预测因素。
方法
我们分析了RuDDS患者的人口统计学（性别、年龄）和临床量表数据以及腰椎MRI表现（Pfirrmann椎间盘退变、Modic类型、终板缺损、椎间盘高度和骨赘）。我们研究了不同年龄组退变改变的患病率，并寻找特定主要综合征患者术后背痛强度的预测因素。
结果
与基于人群的研究相比，保守治疗失败的患者椎间盘和终板退变更严重，Modic改变更多，Jarosz评分更高。与其他主要综合征（小关节疼痛、腰椎间盘突出症、退行性畸形）患者相比，退行性狭窄患者的腰椎退变最严重（<0.004）。腰椎MRI表现对术前背痛强度的影响较弱（β<0.1），但具有统计学意义，对术后背痛有临床显著减轻作用。吸烟对背痛及其术后减轻的影响更大，尤其是在退行性狭窄患者中（β分别为0.307和OR为2.03）。
结论
这是对保守治疗失败患者MRI表现的首次描述。吸烟者术后背痛减轻比不吸烟者更明显；然而，这种治疗效果是否足够尚不清楚。
试验注册号为clinicaltrials.gov上的NCT04600544。
