Boos N, Rieder R, Schade V, Spratt K F, Semmer N, Aebi M
Department of Orthopaedic Surgery, Inselspital, Switzerland.
Spine (Phila Pa 1976). 1995 Dec 15;20(24):2613-25. doi: 10.1097/00007632-199512150-00002.
This was a prospective study of patients (study group) with symptomatic disc herniations and asymptomatic volunteers (control group) matched for age, sex, and work-related risk factors.
To determine the prevalence of disc herniation in a matched group of asymptomatic volunteers and to access the diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations.
Disc herniations have been reported to occur in 20-36% of asymptomatic volunteers. A valid comparison of asymptomatic individuals and patients with disc herniations has not been performed.
Forty-six patients with low back pain and sciatica severe enough to require a discectomy were compared with 46 age-, sex-, and risk factor-matched (heavy lifting, twisting and bending, vibration, and sedentary activity) asymptomatic volunteers. Both groups had a complete clinical and magnetic resonance imaging examination and completed a questionnaire to assess differences in the psychosocial and work perception profiles. The prevalence and the severity of morphologic alterations (disc herniation, disc degeneration, and neural compromise) was analyzed by tow independent radiologists in a blinded fashion. Differences between both groups regarding MRI findings, work perception (occupational mental stress, intensity of concentration, job satisfaction, and job-related resignation) and psychosocial factors (anxiety, depression, self-control, social support, and marital status) were compared using multivariate techniques. Stepwise discriminating analysis was used to identify the best discriminating variables within the magnetic resonance image, work perception, and psychosocial categories in terms of the diagnostic accuracy to predict group membership (study [pain] or control [no pain] group).
Matched controls had significantly more risk factors than a group of normal individuals. The present study has presented evidence that an age-, gender-, and occupational risk factors-matched group of asymptomatic patients shows a high incidence rate of disc herniations (76%). Although significantly less than the symptomatic group incidence of 96%, this represents a much higher prevalence rate than generally expected and reported in other studies of unmatched asymptomatic volunteers. Patients had more severe disc herniations (disc extrusions) than asymptomatic volunteers (35% vs. 13%). There was no significant differences regarding disc degeneration between both groups (96% vs. 85%). The only substantial morphologic difference between both groups was the presence of a neural compromise (83% vs. 22%), which was highly significant (P < 0.0001). There were significant differences between both groups regarding work perception (occupational mental stress, intensity of concentration, job satisfaction, and resignation; P < 0.027) and psychosocial factors (anxiety, depression, self-control, marital status; P < 0.0001). The best single predictor of a group membership was the extent of neural compromise. A combination of this factor with occupational mental stress, depression, and marital status was the best predictive model. With this model, the false-negative rate (potential overtreatment of disc morphology) was reduced by more than half compared with morphologic factors (nerve root compression) alone (22% vs. 11%).
In an age-, sex-, and risk factor-matched group of asymptomatic individuals, disc herniation had a substantially higher prevalence (76%) than previously reported in an unmatched group. Individuals with minor disc herniations (i.e., protrusion, contained discs) are at a very high risk that their magnetic resonance images are not a causal explanation of pain because a high rate of asymptomatic subjects (63%) had comparable morphologic findings. The only highly significant difference between the study group and control group regarding morphologic fi
这是一项针对有症状椎间盘突出症患者（研究组）和年龄、性别及工作相关风险因素相匹配的无症状志愿者（对照组）的前瞻性研究。
确定匹配的无症状志愿者组中椎间盘突出症的患病率，并评估磁共振成像、工作认知及社会心理因素在识别有症状椎间盘突出症方面的诊断准确性。
据报道，20% - 36%的无症状志愿者存在椎间盘突出症。尚未对无症状个体与椎间盘突出症患者进行有效比较。
将46例因严重腰痛和坐骨神经痛而需要进行椎间盘切除术的患者与46名年龄、性别及风险因素（重物搬运、扭转和弯曲、振动及久坐活动）相匹配的无症状志愿者进行比较。两组均接受了完整的临床和磁共振成像检查，并完成了一份问卷以评估社会心理和工作认知概况的差异。两名独立的放射科医生以盲法分析形态学改变（椎间盘突出、椎间盘退变和神经受压）的患病率及严重程度。使用多变量技术比较两组在磁共振成像结果、工作认知（职业心理压力、注意力集中程度、工作满意度和与工作相关的辞职意愿）及社会心理因素（焦虑、抑郁、自我控制、社会支持和婚姻状况）方面的差异。采用逐步判别分析来确定磁共振成像、工作认知和社会心理类别中在预测组成员（研究[疼痛]组或对照[无疼痛]组）诊断准确性方面的最佳判别变量。
匹配的对照组比一组正常个体有更多的风险因素。本研究表明，年龄、性别和职业风险因素相匹配的无症状患者组中，椎间盘突出症的发生率很高（76%）。尽管明显低于有症状组96%的发生率，但这一患病率比其他未匹配的无症状志愿者研究中普遍预期和报道的要高得多。患者的椎间盘突出（椎间盘脱出）比无症状志愿者更严重（35%对13%）。两组之间在椎间盘退变方面无显著差异（96%对85%）。两组之间唯一显著的形态学差异是神经受压情况（83%对22%），差异非常显著（P < 0.0001）。两组在工作认知（职业心理压力、注意力集中程度、工作满意度和辞职意愿；P < 0.027）和社会心理因素（焦虑、抑郁、自我控制、婚姻状况；P < 0.0001）方面存在显著差异。组成员的最佳单一预测指标是神经受压程度。该因素与职业心理压力、抑郁和婚姻状况相结合是最佳预测模型。使用该模型，与仅使用形态学因素（神经根受压）相比，假阴性率（椎间盘形态的潜在过度治疗）降低了一半以上（22%对11%）。
在年龄、性别和风险因素相匹配的无症状个体组中，椎间盘突出症的患病率（76%）比之前未匹配组报道的要高得多。患有轻度椎间盘突出症（即椎间盘膨出、包容性椎间盘）的个体，其磁共振成像结果很可能并非疼痛的病因，因为有很高比例的无症状受试者（63%）有类似的形态学表现。研究组和对照组在形态学方面唯一高度显著的差异是……
