人工诱导突出椎间盘自然回缩后椎间盘的高度测量及强度分析

Measurement of intervertebral disc height and analysis of strength after induced resorption of herniated nucleus pulpous

背景:人工诱导突出椎间盘自然回缩技术是一种治疗颈、腰椎间盘突出症微创、对突出椎间盘而言无创的创新性有效方法,但回缩术后突出颈、腰椎间盘能否保持原有的高度及生物力学强度,目前尚未见相关研究报道。目的:测量人工诱导突出椎间盘自然回缩手术前后突出颈、腰椎间盘相邻椎体形心高度,以分析回缩术后椎间盘生物力学强度的变化,为人工诱导突出椎间盘自然回缩技术治疗颈、腰椎间盘突出症提供新的依据。方法:回顾性分析2013年1月至2023年1月在郑州大学第一附属医院接受人工诱导突出椎间盘自然回缩手术治疗的颈/腰椎间盘突出患者140例。应用相关软件在人工智能辅助标定下,于MRI T_(1)图像中测量患者人工诱导突出椎间盘自然回缩术前及术后各随访时间节点的颈椎、腰椎相邻椎体形心高度。以未手术的T_(1)/T_(2)和T_(12)/L_(1)节段分别作为颈椎、腰椎对照组,若术前颈/腰椎间盘突出患者的相邻椎体形心高度值小于其自身T_(1)/T_(2)或T_(12)/L_(1)对照节段相邻椎体形心高度值超过8%者为“高度降低组”(以下简称A组),其余为“高度不变组”(以下简称B组)。统计学分析A组和B组人工诱导突出椎间盘自然回缩手术前后相邻椎体形心高度的差异,同时根据人工智能辅助测量所得颈、腰椎突出椎间盘的体积,分析其与相邻椎体形心高度变化的相关性。结果与结论:①共纳入140例患者,其中颈椎组60例、腰椎组80例,术后随访7 d-12个月;②颈椎组共281个椎间盘,其中对照组60个颈椎间盘,术前与术后末次随访相邻椎体形心高度平均值分别约为20.46 mm和20.17 mm,差异无显著性意义(P>0.05);A组162个颈椎间盘,术前与术后末次随访相邻椎体形心高度均值分别为16.65 mm和15.92 mm,差异无显著性意义(P>0.05);术前与术后颈椎突出椎间盘体积均值分别是510.28 mm^(3)和364.76 mm^(3),与相邻椎体形心高度改变无显著相关性(P>0.05);B组64个颈椎间盘,术前与术后末次随访相邻椎体形心高度平均值分别为20.15 mm和19.09 mm,差异无显著性意义(P>0.05);术前与术后颈椎突出椎间盘体积平均值分别是515.32 mm^(3)和361.98 mm^(3),与相邻椎体形心高度改变无显著相关性(P>0.05);③腰椎组共258个椎间盘,其中对照组80个腰椎间盘,术前与术后末次随访相邻椎体形心高度平均值分别约为33.03 mm和32.40 mm,差异无显著性意义;A组59个腰椎间盘,术前与术后末次随访相邻椎体形心高度平均值分别为30.08 mm和31.67 mm,差异无显著性意义;术前与术后腰椎突出椎间盘体积均值分别是690.51 mm^(3)和496.58 mm^(3),与相邻椎体形心高度改变无显著相关性(P>0.05);B组119个腰椎间盘,术前与术后末次随访相邻椎体形心高度平均值分别为35.91 mm和34.12 mm,差异无显著性意义;术前与术后腰椎突出椎间盘体积均值分别是698.70 mm^(3)和535.99 mm^(3),与相邻椎体形心高度改变无显著相关性;④提示无论颈、腰椎突出椎间盘高度是否下降,人工诱导突出椎间盘自然回缩术后其高度都可以维持与术前一致的水平,可见突出椎间盘回缩并不影响其生物力学强度,提示人工诱导突出椎间盘自然回缩技术宜在突出节段椎间隙高度下降前实施,这样对维持自然回缩椎间盘生物力学强度更具价值。

BACKGROUND:Induced resorption of herniated nucleus pulpous is a minimally invasive,non-invasive and innovative method for the treatment of cervical/lumbar intervertebral disc herniation.After induced resorption of herniated nucleus pulpous,the research about whether cervical/lumbar intervertebral disc can maintain the original biomechanical strength has not been reported.OBJECTIVE:To measure the height of adjacent vertebral centroid of cervical/lumbar intervertebral disc before and after induced resorption of herniated nucleus pulpous operation to analyze the changes of the biomechanical strength of the intervertebral disc after reclining and to provide a new basis for induced resorption of herniated nucleus pulpous treatment of cervical and lumbar intervertebral disc herniation.METHODS:A retrospective analysis was performed on 140 patients with cervical/lumbar intervertebral disc herniation who received induced resorption of herniated nucleus pulpous surgery in the First Affiliated Hospital of Zhengzhou University from January 2013 to January 2023.Related software was used to measure the height of adjacent vertebral centroid of cervical/lumbar intervertebral disc of patients at each follow-up time point before and after induced resorption of herniated nucleus pulpous surgery in Magnetic Resonance Imaging image data under Artificial Intelligence-assisted calibration.Unoperated T_(1)/T2 and T_(12)/L_(1)segments were taken respectively as controls.Those with preoperative height of adjacent vertebral centroid less than 8%of the corresponding T_(1)/T2 or T_(12)/L_(1)control segment were in the“height reduction group”(hereafter referred to as group A)and the rest were in the“height unchanged group”(hereafter referred to as group B).The difference of height of adjacent vertebral centroid before and after operation between the group A and the group B was statistically analyzed.Simultaneously,the correlation between the volume of cervical and lumbar herniated discs and the changes of height of adjacent vertebral centroid was analyzed according to the result measured by artificial intelligence.RESULTS AND CONCLUSION:(1)The study maintained a total of 140 patients,including 60 cases of cervical disc herniation and 80 cases of lumbar disc herniation.The postoperative follow-up period was 7 days to 12 months.(2)A total of 281 discs were measured in the cervical vertebra group,including 60 intervertebral discs in the control group.The mean value of height of adjacent vertebral centroid before and at the last postoperative follow-up was about 20.46 mm and 20.17 mm,respectively,with no statistical difference(P>0.05).There were 162 cervical discs in group A.The average height of adjacent vertebral centroid before and after operation was 16.65 mm and 15.92 mm,respectively,with no statistically significant difference(P>0.05).The mean cervical disc herniation volume before and after surgery was 510.28 mm^(3)and 364.76 mm^(3),respectively,which was not significantly correlated with height of adjacent vertebral centroid change(P>0.05).There were 64 discs in the group B,with average of 20.15 mm before operation and 19.09 mm at the last follow-up,and there was no significant difference(P>0.05).The mean volume of cervical disc herniation before and after surgery was 515.32 mm^(3)and 361.98 mm^(3),respectively,and there was no significant correlation with the change of height of adjacent vertebral centroid(P>0.05).(3)A total of 258 discs were measured in the lumbar spine group,of which 80 intervertebral discs in the control group,the average height of adjacent vertebral centroid was 33.03 mm before operation and 32.40 mm at the last follow-up,and there was no significant difference.There were 59 discs in the group A,and the average height of adjacent vertebral centroid before and after operation was 30.08 mm and 31.67 mm,respectively,with no statistically significant difference.The mean volume of lumbar disc herniation before and after operation was 690.51 mm^(3)and 496.58 mm^(3),respectively,and there was no significant correlation with the change of height of adjacent vertebral centroid(P>0.05).There were 119 discs in the group B,with an average height of adjacent vertebral centroid of 35.91 mm before surgery and 34.12 mm at the last follow-up.The mean volume of lumbar disc herniation before and after operation was 698.70 mm^(3)and 535.99 mm^(3),respectively,and there was no significant correlation with the change of height of adjacent vertebral centroid.(4)It is concluded that patients with cervical/lumbar intervertebral disc herniation can maintain the same intervertebral height level after induced resorption of herniated nucleus pulpous regardless of whether the intervertebral height has decreased before operation.It can be inferred that the resorption of the herniated disc does not affect its biomechanical strength.It suggests that induced resorption of herniated nucleus pulpous surgery should be performed before the intervertebral height of the degenerate segment has decreased.The induced resorption of herniated nucleus pulpous is more valuable to maintain the biomechanical strength of the resorptive disc.