腰椎间盘退变MRI:与Modic改变相关的影像学分析

Magnetic resonance imaging of lumbar intervertebral discs degeneration:Analysis of the imaging manifestations related to Modic changes

背景:部分椎间盘源性下腰痛患者MRI可出现Modic改变,但Modic改变的相关因素及Modic改变与椎间盘退变之间因果关系目前尚不十分清楚。目的:分析存在腰椎间盘Modic改变的下腰痛患者性别、年龄分布特点及腰椎间盘发生Modic改变的相关因素。方法:回顾性分析634例(2536个椎间盘)存在腰椎间盘Modic改变患者的性别、年龄分布特点,并分析腰椎间盘Modic改变与椎间盘突出或膨出、Schmorl结节、椎体滑脱、椎间盘解剖水平及椎间盘退行性改变程度的相关性。结果与结论:634例患者中,女性患者ModicⅡ、Ⅲ型出现率均较男性高,而ModicⅠ型出现率小于男性患者(P<0.001);40岁以上患者较40岁以下患者Modic各型改变的出现率均高(P<0.001)。2536个腰椎间盘中,有椎体滑脱、出现Schmorl结节、有椎间盘突出或膨出者Modic各型改变的出现率均比无此类表现者高(P<0.001);L4/5、L5/S1水平(低位)Modic各型改变的出现率均比L2/3、L3/4水平(高位)高(P<0.001);椎间盘退行性改变越严重,Modic各型改变的出现率越高(P<0.001)。椎间盘退行性改变分级、Schmorl结节与Modic改变有显著相关性。结果说明,腰椎间盘Modic改变与患者性别、年龄、椎间盘有无突出或膨出、有无Schmorl结节、椎体有无滑脱、椎间盘解剖水平及椎间盘退行性改变分级均有相关性。其中,椎间盘退行性改变分级、Schmorl结节与腰椎间盘Modic改变间的相关性最高,且椎间盘退行性改变分级较Schmorl结节与之相关性更高。

BACKGROUND： Part of the discogenic low back pain patients’ MRI shows Modic changes, but the relevant factors of Modic changes and the causal relationship between Modic changes and disc degeneration remain unclear. OBJECTIVE： To explore the distribution of the Modic changes of lumbar intervertebral discs in patients （gender and age） suffering low back pain and to explore the correlated factors of the Modic changes. METHODS： 634 patients （2 536 lumbar intervertebral discs） suffering low back pain were examined by Magnetic resonance imaging scan. The distribution character of the Modic changes of lumbar intervertebral discs among different ages and between different genders were analyzed, and the correlation between Modic changes and lumbar intervertebral disc herniation, Schmorl nodes, lumbar instability, lumbar segments, and the degeneration degree of lumbar intervertebral discs were analyzed, too. RESULTS AND CONCLUSION： Among 634 patients, the occurrence rate of Modic Ⅱ and Modic Ⅲ in female was higher than that in male, but the occurrence rate of Modic I in female was lower than that in the male （P 0.001）. The occurrence rates of Modic Ⅰ-Ⅲ among people over 40 years were higher than that in people aged under 40 years （P 0.001）. Among 2 536 lumbar discs, the occurrence rates of Modic Ⅰ-Ⅲ among people who have lumbar instability or Schmorl nodes or lumbar intervertebral disc herniation were all higher than those in the people who do not have the performance （P 0.001）. The occurrence rates of ModicⅠ-Ⅲ in the segment L 4/5 and L 5 /S 1 （the lower level） were higher than those in the segment L 2/3 and L 3/4 （the higher level） （P 0.001）. The more serious the lumbar discs degeneration changes are, the higher the occurrence rates of Modic Ⅰ-Ⅲ will be （P 0.001）. There were markedly correlation among the degeneration degrees of lumbar intervertebral discs, Schmorl nodes and Modic changes. There are correlations between Modic changes and patients’ age, patients’ gender, lumbar intervertebral disc herniation, Schmorl nodes, lumbar intervertebral instability, lumbar segments, and the degeneration degree of lumbar intervertebral discs. The degeneration degrees of lumbar intervertebral discs and Schmorl nodes have highly correlation with Modic changes, and the degeneration degree of lumbar intervertebral discs has a higher correlation with Modic changes than Schmorl nodes.