Liang Guzhen, Chang Hengrui, Zhu Lin, Wang Zhaoxuan, Kou Junkai, Ren Jianhua, Meng Xianzhong
The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Hebei Medical University, Shijiazhuang, China.
Eur Spine J. 2025 Sep 5. doi: 10.1007/s00586-025-09339-1.
This study examines the association between neurogenic injury and lumbar intervertebral disc degeneration (LDD) in tethered cord syndrome (TCS) by comparing lumbar sagittal parameters and disc degeneration between patients with normal and abnormal somatosensory evoked potential (SSEP) findings.
We retrospectively analyzed clinical data from 43 patients diagnosed with TCS between July 2018 and July 2024. Based on tibial nerve somatosensory evoked potential (SSEP) examination results, patients were categorized into SSEP-normal and SSEP-abnormal groups. Demographic and clinical characteristics including height, weight, sex, age, BMI, smoking status, alcohol consumption, hypertension, and diabetes were recorded. Lumbar spine MRI T2-weighted images provided measurements of intervertebral disc degeneration grade, disc height, disc angle, lumbosacral angle, and lumbar lordosis angle. Statistical comparisons between groups employed chi-square tests, independent t-tests, Mann-Whitney U tests, and Fisher's exact tests. Spearman correlation analysis assessed relationships between SSEP abnormalities and degeneration grades across lumbar segments.
Of the 43 patients, 27 exhibited abnormal SSEP. The abnormal group demonstrated significantly higher LDD grades at L2-S1, with the strongest correlation at L5-S1 (P < 0.05). Overall and multi-segmental degeneration rates were elevated in this group. While lumbosacral and lumbar lordosis angles were larger in the abnormal group, these differences lacked statistical significance. The L5-S1 disc angle was significantly larger in the abnormal group (P < 0.05), whereas disc height did not differ between groups.
Patients with TCS and abnormal SSEP, reflecting more severe neurogenic injury, exhibited significantly more severe and widespread lumbar disc degeneration, particularly at caudal segments. These findings suggest that in TCS, the degree of neurogenic compromise may influence the severity of disc degeneration. Moreover, our results raise the possibility of a dynamic interaction between neural injury and spinal structural changes in the pathophysiology of TCS. This hypothesis warrants confirmation in larger, prospective studies using MRI and multimodal electrophysiology.
本研究通过比较体感诱发电位（SSEP）结果正常和异常的患者的腰椎矢状位参数及椎间盘退变情况，探讨脊髓拴系综合征（TCS）中神经源性损伤与腰椎间盘退变（LDD）之间的关联。
我们回顾性分析了2018年7月至2024年7月期间诊断为TCS的43例患者的临床资料。根据胫神经体感诱发电位（SSEP）检查结果，将患者分为SSEP正常组和SSEP异常组。记录人口统计学和临床特征，包括身高、体重、性别、年龄、BMI、吸烟状况、饮酒情况、高血压和糖尿病。腰椎MRI T2加权图像用于测量椎间盘退变程度、椎间盘高度、椎间盘角度、腰骶角和腰椎前凸角。组间统计比较采用卡方检验、独立t检验、Mann-Whitney U检验和Fisher精确检验。Spearman相关性分析评估SSEP异常与腰椎各节段退变程度之间的关系。
43例患者中，27例SSEP异常。异常组在L2-S1节段的LDD分级显著更高，在L5-S1节段相关性最强（P < 0.05）。该组总体和多节段退变率升高。虽然异常组的腰骶角和腰椎前凸角更大，但这些差异无统计学意义。异常组L5-S1椎间盘角度显著更大（P < 0.05），而两组间椎间盘高度无差异。
SSEP异常的TCS患者反映出更严重的神经源性损伤，表现出明显更严重和广泛的腰椎间盘退变，尤其是在尾端节段。这些发现表明，在TCS中，神经源性损伤程度可能影响椎间盘退变的严重程度。此外，我们的结果提出了在TCS病理生理学中神经损伤与脊柱结构变化之间动态相互作用的可能性。这一假设有待在使用MRI和多模态电生理学的更大规模前瞻性研究中得到证实。
