腰椎终板Modic改变与椎间盘退变对应关系及二者与下腰痛关系的分析

The matched association between Modic changes with lumbar disc degeneration and their association with low back pain

目的:研究腰椎终板Modic改变类型与椎间盘退变的关系及二者与下腰痛(low back pain,LBP)的关系。方法:选取2016年10—12月间行腰椎MRI检查且合并Modic改变的患者200例。Pfirrmann分级评估腰椎间盘退变。通过电话随访,采用VAS法评估LBP。统计Modic改变及邻近椎间盘退变在下腰段(L4/5及L5/S1水平)的分布情况及关系,及二者与LBP的关系。结果:ModicⅡ型与Ⅱ-Ⅰ型均与轻度椎间盘退变相关(P <0.05)。ModicⅠ-Ⅱ型与轻度及严重椎间盘均相关(P <0.05),而ModicⅠ型与严重椎间盘退变相关(P <0.05)。ModicⅠ型、Ⅱ型及Ⅰ-Ⅱ型与LBP相关(P <0.05)。多因素分析后,严重椎间盘退变(4级)与LBP相关性消失(P> 0.05)。结论:退变程度较高的腰椎间盘易合并ModicⅠ型,ModicⅡ型更常见于退变程度较低的腰椎间盘;退变初始阶段,ModicⅡ型可能向Ⅰ型转换。虽然Modic改变与腰椎间盘退变均与LBP相关,Modic改变的影响可能更直接,而腰椎间盘退变通过Modic改变间接产生影响,因此较弱。

Objective:To study the association between different types of Modic changes and lumbar disc degeneration,as well as their association with low back pain(LBP)further. Methods:Two hundred individuals with lumbar Modic changes had magnetic resonance imaging(MRI)from Oct to Dec 2016. Lumbar disc degeneration was determined by the Pfirrmann grading system. Intensity of LBP was evaluated via a 10-cm visual analog scale(VAS)through telephone interviews. The distribution of Modic changes and disc degeneration in lower segments(L4/5 and L5/S1 level)along with their associations,as well as their association with LBP,was analyzed. Results:Modic Ⅱ and Ⅱ-Ⅰwere associated with lower disc degeneration(grade 3,P < 0.05). Modic Ⅰ-Ⅱ was associated with both lower(grade 3)and severe(grade 4)degenerative discs(P < 0.05),while Modic Ⅰcorrelated to severe disc degeneration(grade 4,P < 0.05). Modic Ⅰ,Ⅱ and Ⅰ-Ⅱ were associated with LBP(P < 0.05). Significant association between severe disc degeneration(grade 4)and LBP lost in multivariate analyses(P > 0.05). Conclusion:Severe lumbar degenerative discs are more likely to be accompanied with Modic Ⅰ,while Modic Ⅱ with lower disc degeneration. At the early stage of degenerative process,Modic Ⅱmay change to Modic Ⅰ. Although both causing LBP,lumbar disc degeneration may exert indirect weak influence on LBP through the direct impact of Modic changes.