Buttermann G R, Heithoff K B, Ogilvie J W, Transfeldt E E, Cohen M
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, USA.
Eur Spine J. 1997;6(2):115-20. doi: 10.1007/BF01358743.
The evaluation of continued pain after a technically successful posterolateral lumbar spine fusion is often challenging. Although the intervertebral disc is often a source of low back pain, abnormal endplates may also be a focus of pain, and possibly a source of continued pain after a posterolateral fusion. MRI allows noninvasive evaluation for disc degeneration, as well as for abnormal endplates and adjacent vertebral body marrow. Previous studies have found inflammatory marrow changes, adjacent to abnormal endplates, associated with disc degeneration in low back pain patients. In this study, preoperative MRI scans in 89 posterolateral lumbar fusion patients were reviewed, by an independent radiologist, to determine whether vertebral body marrow changes adjacent to the endplates were related to continued pain. Independent chart review and follow-up telephone interview of all patients at a 4-year follow-up (mean) formed the basis for the clinical results. Vertebral body MRI signals consistent with inflammatory or fatty changes were found in 38% of patients, and always occurred adjacent to a degenerated disc. Inflammatory MRI vertebral body changes were significantly related to continued low back pain at P = 0.03. We conclude that posterolateral lumber fusion has a less predictable result for the subset of degenerative disc patients with abnormal endplates and associated marrow inflammation. More research is needed to determine the biological and biomechanical effects of posterolateral fusion upon the endplate within the fused segments. If indeed further study supports the hypothesis that abnormal endplates associated with inflammation are a source of pain, then treating the endplates directly by anterior fusion may be a preferred treatment for this subset of degenerative patients.
在腰椎后路融合技术成功后，对持续性疼痛的评估往往具有挑战性。虽然椎间盘常常是下腰痛的一个来源，但异常的终板也可能是疼痛的焦点，并且可能是后路融合术后持续性疼痛的一个来源。磁共振成像（MRI）能够对椎间盘退变、异常终板及相邻椎体骨髓进行无创评估。既往研究发现，下腰痛患者中，与椎间盘退变相关的异常终板附近存在骨髓炎症改变。在本研究中，一名独立放射科医生对89例腰椎后路融合患者的术前MRI扫描进行了回顾，以确定终板附近的椎体骨髓改变是否与持续性疼痛相关。对所有患者进行4年（平均）的独立病历审查和随访电话访谈，构成了临床结果的基础。38%的患者发现椎体MRI信号符合炎症或脂肪改变，且总是出现在退变椎间盘附近。炎症性椎体MRI改变与持续性下腰痛显著相关，P = 0.03。我们得出结论，对于终板异常及相关骨髓炎症的退行性椎间盘患者亚组，腰椎后路融合的结果较难预测。需要更多研究来确定后路融合对融合节段内终板的生物学和生物力学影响。如果进一步研究确实支持与炎症相关的异常终板是疼痛来源这一假设，那么对于这一退行性患者亚组，通过前路融合直接治疗终板可能是一种更好的治疗方法。
