颈椎终板Modic改变在颈肩痛病例中的分布和相关因素分析

目的 探讨颈椎终板Modic改变在颈肩痛病例中的临床分布特点,并探讨其发生的相关因素.方法 选择2006年一年内因颈肩痛而在本院行颈椎MR和常规X线检查的患者共1023例,回顾性分析颈椎MR中所表现的Modic改变在人群、椎间盘节段、年龄、颈椎曲度和椎间盘退变分级中的分布特点以及其发生的相关因素.结果 1023例共计6138个颈椎椎间盘中90例(8.8％),108(1.8％)个椎间盘邻近终板发生Modic改变.I型32例(3.1％),34个椎间盘(0.6％);Ⅱ型55例(5.4％),71个椎问盘(1.2％)Ⅲ型3例(0.3％),3个椎间盘(0.06％).按照各个椎间盘节段发病数统计,C2-3 O个、C3-4 10个、C415 18个、C5-6 52个、C6-7 23个、C7 T1 5个,发病率分别为O％、0.2％、0.4％、1.0％、0.4％、0.1％.Modic改变和椎间盘退变明显相关(P=0.000).40岁以上是Modic改变发生较多的年龄段(P=0.000).通过Binary Logistic检验逐步回归法得出回归方程为y=一15.514+3.047D+0.684C+0.210L+0.152,4(y为Modic改变、A为年龄、L为椎问盘节段、D为椎间盘退变程度、C为Cobb角分组),P=0.000,EXP值,D=21.048,C=I.982,L=1.233,A=1.164.结论 颈椎终板Modic改变发生率较腰椎低,其发生和椎间盘退变、椎间盘节段、年龄和颈椎曲度之间存在相关性,椎问盘退变是最重要的影响因素.Ⅱ型最为多见,I型次之,Ⅲ型最为少见,多发生于C3-6椎间盘.40岁以上是Modie改变易发年龄.     

颈椎椎体终板区Modic退变的MRI评价

目的总结颈椎椎体终板Modic退变的发病情况,探讨其临床意义。方法回顾分析136例颈椎病患者的颈椎MRI矢状位图像资料,记录椎体终板Modic退变的发生率、发生节段及退变类型,统计Modic改变在颈椎各节段的分布。结果136例颈椎病患者中有23例存在Modic退变,发生率为16．9％。患者平均年龄为50．6岁。男性患者中发生率为17．7％,女性为15％。最常出现Modic退变的节段为C5,6。ModicⅠ型、Ⅱ型和Ⅲ型的发生率分别为4．4％、7．4％、5．1％。结论颈椎病患者存在椎体终板区Modic退变现象,退变以Ⅱ型最多,以C5,6节段最为常见。     

颈椎Modic改变研究现状

Modic改变是指椎体终板及终板下骨质在MRI上的信号异常改变。颈椎Modic改变以Ⅱ型为主,节段以C_(5、6)为主。其发生与高龄和椎间盘退变相关性较强。颈椎Modic改变是否会产生相关临床症状仍有争议。手术治疗颈椎病伴颈椎Modic可获得良好疗效,颈椎Modic改变和手术疗效互相影响。     

颈椎曲度和活动度参数的影响因素

 目的 探讨颈椎曲度和活动度的测量参数及影响因素。方法 回顾性分析2012年1月至2013年6月,212位正常志愿者的颈椎标准侧位、前屈位、后伸位X线片,男84位,女128位;年龄20~79岁,以10年为一组,分成6组;颈椎间盘退变程度依据颈椎9分法,分为4组。影像资料由3名脊柱外科医生分3次运用Mimics软件测量。测量参数包括C2~C7曲度及椎间各节段和整体活动度。对颈椎曲度和整体活动度的关系进行Pearson 相关性分析,对年龄、性别和间盘退变三个因素进行多重线性回归分析。组内相关系数（ICC）评估测量者组内和组间一致性。结果 C₂~C₇曲度为21.40°±12.15°,C₂~C₇整体活动度为 63.59°±15.37°。性别对颈椎曲度的影响有统计学意义（回归系数=-2.472,P＜ 0.05）。性别和年龄两因素对颈椎整体活动度的影响有统计学意义（回归系数=3.863和-6.463,P＜0.05）。性别对C_2,3、C_5,6两个节段活动度的影响有统计学意义;年龄对C₂~C₇所有五个节段活动度的影响有统计学意义;间盘退变对C_4,5、C_5,6和C_6,7三个节段活动度的影响有统计学意义。颈椎曲度与颈椎整体及后伸活动度无明显相关性（r=-0.106和0.215,P＞0.05）,但与前屈活动度呈负相关（r=-0.401,P＜0.05）。颈椎曲度、整体活动度和节段活动度的测量结果均具有很高的组内一致性（ICC=0.97,0.96~0.97;ICC=0.91,0.90~0.92;ICC=0.89,0.87~0.91）和组间一致性（ICC=0.94,0.92~0.95;ICC=0.89,0.86~0.91;ICC=0.83,0.79~0.86）。结论 性别是颈椎曲度的影响因素,性别和年龄两因素是颈椎整体活动度的影响因素,性别、年龄和间盘退变程度是颈椎节段活动度的影响因素。     

颈椎不同位置下甲状软骨对应颈椎节段的影像学研究

目的 研究颈椎退变病人不同体位下的甲状软骨与颈椎节段的对应关系。方法 搜集2018年1月至2018年7月100例行颈前路手术病人的术前X线影像资料,测量甲状软骨前缘中点对应的颈椎节段,描述颈椎不同位置下对应节段的分布关系,并分析影响其变化的相关因素。结果 中立位状态下,甲状软骨对应的节段主要分布在C₅~C₆范围,占93.0％（93/100）;过伸位状态下,甲状软骨对应的节段主要分布在C_4/5~C_5/6范围,占82.0％（82/100）。影响甲状软骨对应节段的最主要因素是性别。颈椎过伸位下,男性病人甲状软骨对应节段主要分布在C₅和C_5/6,占78.6%（44/56）;女性病人甲状软骨的对应节段主要分布在C_4/5和C₅,占72.7％（32/44）;女性甲状软骨对应节段要高于男性。上述指标比较,差异具有统计学意义（P均＜0.05）。结论 颈椎不同位置下甲状软骨的对应节段存在差异,随着颈部的后伸运动,甲状软骨对应的颈椎节段呈上移的规律;甲状软骨的位置存在性别差异,女性甲状软骨对应节段的位置相对较高。     

Modic改变在腰腿痛病例中的分布及相关因素分析

目的探讨腰椎终板Modic改变在腰腿痛病例中的的临床分布特点，并探讨发生Modic改变的相关因素。方法选择2005年一年内因腰痛或坐骨神经痛行腰椎MR检查和常规X线检查的患者1223例，分析腰椎MRI中终板Modic改变在椎间盘节段、年龄和椎间盘退变分类中的分布特点及其相关因素。结果1223例6115个腰椎椎间盘中，257例（21．0％）320个椎间盘（5．2％）邻近终板发生M0dic改变，其中Ⅰ型48例（3．9％）51个椎间盘（0．8％），Ⅱ型206例（16．8％）266个椎间盘（4．3％）、Ⅲ型3例（0．2％）3个椎间盘（0．05％）。椎间盘节段L5S1 168个、L4-5 95个、L3-4 29个、L2-3 18个、L1-2 10个，发生率分别为13．7％、7．8％、2．4％、1．5％、0．8％。突出、脱出和滑脱病例发生率较高（辟0．00）。女性发生率高于男性（P=0．005）。40岁以上是Modic改变发生较多的年龄段（P=0．001）。椎间盘退变程度、椎间盘节段与年龄均和Modic改变具有显著相关性（P=0．000）。回归方程为Y=-5．955＋0．198A＋1．528L＋1．883D（Y为M0dic改变，A为年龄，L为椎间盘节段，D为椎间盘退变程度），P=0．000，EXP值：D=6．571，L=4．609，A=1．220。结论腰椎终板Modic改变和椎间盘退变、椎间盘节段和年龄之间存在相关关系，椎间盘退变是最重要的影响因素。Modic改变Ⅱ型最多，Ⅰ型次之，Ⅲ型最少；多发生于L4-5和L5S1椎间盘节段；女性高于男性；40岁以上是易发年龄。     

腰椎损伤疝出型和退变突出型椎间盘组织 白细胞介素17表达与Modic 改变的关系

 目的观察白细胞介素17(interleukin-17,IL-17)在腰椎间盘突出症(lumbar disc herniation,LDH)损伤疝出型和退变突出型椎间盘组织中表达的差异,以及LDH病变节段Modic改变的情况,探讨Modic改变与突出类型的相关性及可能的病理机制。方法选取2009年2月至10月确诊并手术治疗的单节段LDH患者50例。根据临床诊断标准、影像学(CT及MR)检查结果以及手术所见将病例分为损伤疝出组35例,退变突出组15例。根据MRI将病例分为Modic改变组14例,非Modic改变组36例。收集椎间盘标本,采用HE染色、免疫组织化学染色和实时荧光定量PCR检测观察椎间盘组织病理变化及IL-17的表达。结果(1)损伤疝出组中肉芽组织、新生血管化明显高于退变突出组。(2)损伤疝出组标本中IL-17阳性细胞数明显高于退变突出组,Modic改变组IL-17阳性细胞数明显高于非Modic改变组,差异均有统计学意义。(3)损伤疝出组椎间盘组织中IL-17mRNA的表达量与退变突出组的比值为6.7701,Modic改变组与非Modic改变组的比值为4.2836。(4)损伤疝出型LDH与Modic改变之间的相关性分析显示两者存在相关性。 结论(1)损伤疝出型椎间盘髓核组织可以引起更为明显的局部炎性反应;(2)IL-17在损伤疝出型椎间盘表达明显,提示IL-17介导了椎间盘神经根微环境的免疫炎症变化;(3)自身免疫反应参与了Modic改变的病理生理机制,并且很可能发挥重要作用。     

腰椎退行性疾病手术病人术前邻近节段椎间盘的退变情况及分布规律

目的 观察腰椎退行性疾病手术病人术前邻近节段椎间盘的退变情况及分布规律。方法 回顾性分析济南军区总医院2012年1月至2016年2月收治的503例行手术治疗腰椎退行性疾病病人的术前临床资料,其中男240例（47.71%）,女263例（52.29%）;年龄为20~84岁,平均48.8岁。腰椎间盘突出症352例,退变性腰椎滑脱症91例,退变性腰椎管狭窄症60例。通过术前X线片评估腰椎稳定性;基于术前MRI,采用Pfirrmann分级标准评价腰椎间盘退变程度,记录Modic改变、高信号区域及许莫氏结节的发生情况。结果 503例中仅5例为单节段退变,12例为跳跃节段退变,余486例均为多节段退变。共1 863个（1 863/2 515,74.08%）腰椎间盘发生退变,5个节段椎间盘（L_1~2、L_2~3、L_3~4、L_4~5、L₅~S₁）均退变的病人比例为39.56%（199例）。不稳定节段数为127个,Modic改变为188个,高信号区域为241个,许莫氏结节节段数为161个。30岁以下男性病人腰椎间盘退变率较女性高;随着年龄增长,女性病人椎间盘退变率增加,退变程度加重。腰椎不稳、Modic改变、高信号区和许莫氏结节均与椎间盘退变存在明显相关性（P均＜0.05）。某一腰椎节段（L_3~4、L_4~5、L₅~S₁）椎间盘发生Pfirrmann Ⅳ、Ⅴ级退变时,邻近节段椎间盘退变（Pfirrmann Ⅲ+Ⅳ+Ⅴ级）比例均超过了80%,且严重退变（Pfirrmann Ⅳ+Ⅴ级）比例也较高,超过60%。结论 术前邻近节段椎间盘退变广泛存在,在临床工作中要予以重视。     

常见颈椎人工椎间盘假体尺寸与国人颈椎解剖学参数的关系

目的 对比分析常见颈椎人工椎间盘假体尺寸与我国健康成人颈椎解剖学参数的关系,为国人颈椎椎间盘假体的设计提供参考。方法 2015年1月—2018年12月在泰州市人民医院接受颈椎CT平扫的健康成人130名,其中男78名、女52名,年龄为18.0 ~ 66.0（41.41±12.03）岁。使用影像存档与传输系统（PACS）对C₃/C₄/C₅/C₆/C₇节段的解剖结构进行测量,测量参数包括椎体终板前后径（AP）、椎间隙高度（DH）、椎体前缘高度（ADH）、椎体后缘高度（PDH）、椎体终板横径（ML）及钩突间距（IDUP）。分析不同节段、性别、年龄组各解剖学参数的差异,并与常见的8种假体尺寸进行对比分析。结果 共520个节段纳入分析,其中AP为（16.08±1.84）mm,DH为（5.73±1.00）mm,ADH为（3.88±1.11）mm,PDH为（2.83±0.94）mm,ML为（16.13±1.99）mm,IDUP为（23.68±2.55）mm,ML/AP为1.01±0.13。PDH在不同节段之间差异无统计学意义（P > 0.05）,其余各指标在不同节段之间的差异均有统计学意义（P < 0.05）;C₃/C₄和C₅/C₆节段的ADH,C₅/C₆和C₆/C₇节段的DH,C₄/C₅、C₅/C₆和C₆/C₇节段的PDH性别间差异无统计学意义（P > 0.05）,其余各节段的各指标性别间差异均有统计学意义（P < 0.05）;C₅/C₆和C₆/C₇节段的AP在不同年龄组间差异有统计学意义（P < 0.05）,其余各节段的各指标在不同年龄组间差异均无统计学意义（P > 0.05）。与常见的8种颈椎人工椎间盘假体尺寸的对比结果显示,假体AP、ML尺寸与研究对象椎体终板AP、ML测量值的匹配度不理想,假体高度与研究对象DH测量值匹配度较差。结论 常见的不同品牌假体尺寸与我国健康成人的颈椎解剖学参数匹配度不是很理想,未来可设计更符合国人解剖学特征的颈椎人工椎间盘假体。     

颈椎人工椎间盘置换术患者选择与异位骨化形成的相关性分析

 目的 分析颈椎人工椎间盘置换术患者选择与术后异位骨化形成的相关性。方法 回顾性分析2003年12月至2008年12月,48例接受Bryan人工颈椎间盘置换术且随访时间超过5年的患者资料,男21例,女27例;年龄20~53岁,平均42岁;脊髓型颈椎病34例,神经根型颈椎病14例;单节段置换术38例,包括C_3-4 3例、C_4-5 5例、C_5-6 28例、C_6-7 2例;双节段置换术9例,包括C_4-5、C_5-6 4例、C_5-6、C_6-7 5例;三节段置换术1例（C_3-4、C_4-5、C_5-6）;共59个手术节段。在术后颈椎侧位X线片上使用McAfee分级法评价异位骨化形成。使用Logistic回归分析患者性别、术前手术节段活动度、置换节段脊柱功能单位曲度、置换节段与相邻节段椎间隙高度比值等因素与术后异位骨化形成的关系。对阳性结果及其选择阈值采用接受者操作特征（receiver operating characteristic, ROC）曲线及曲线下面积（area under the ROC curve, AUC）进行检验和量化分析。结果 48例患者术后均获得5年以上随访,随访时间60~120个月,平均70.3个月。术后59个节段中,20个出现异位骨化,发生率为33.9%（20/59）。患者性别、节段活动度、置换节段脊柱功能单位曲度和术前置换节段椎间隙高度这四方面因素中,仅术前置换节段与相邻节段椎间隙高度比值与术后异位骨化的形成具有显著相关性。通过ROC曲线分析该因素的AUC为0.813,95%置信区间为0.666~0.959,据此计算出病变节段与相邻节段椎间隙高度比值的临床最佳判断阈值为0.9。结论 患者选择相关临床因素中的术前置换节段椎间隙高度与术后异位骨化形成具有相关性;针对可变旋转中心的Bryan颈椎人工椎间盘假体,术前病变节段椎间隙高度较相邻节段丢失超过10%者不适合行人工椎间盘置换术。     

Effect of endplate reduction on endplate healing morphology and intervertebral disc degeneration in patients with thoracolumbar vertebral fracture

Objective

To determine the effect of endplate reduction on the final healing morphology and degenerative changes in intervertebral discs.

Methods

Forty-eight patients with single-level thoracolumbar fractures with endplate injury were included. All patients underwent posterior reduction and pedicle screw fixation, and postoperative imaging was used to determine whether endplate reduction was successful. The healing morphology of the endplate was divided into three types: increased endplate curvature, irregular healing and traumatic Schmorl node. MRI was performed at baseline and at the last follow-up evaluation to observe changes in disc degeneration (disc height and nucleus pulposus signal) and Modic changes.

Results

The reduction rate in the central area was significantly lower than that in the peripheral area (P = 0.017). In patients with successful reduction, 90.9% (20/22) of the endplates healed with increased curvature. In patients with an unsuccessful endplate reduction, 63.4% (26/41) of the endplates healed irregularly, and 34.1% (14/41) of the endplates formed traumatic Schmorl nodes. Endplate reduction was closely related to the final healing morphology of the endplate (P < 0.001), which had a significant protective effect on the degeneration of the intervertebral disc. At the last follow-up evaluation, there was no statistically significant correlation between different endplate healing morphologies and new Modic changes.

Conclusions

The reduction rate in the central area is significantly lower than that in the peripheral area. Although all of the intervertebral discs corresponding to fractured endplates had degenerated to different degrees, successful endplate fracture reduction can obviously delay the degeneration of intervertebral discs.

     

Modic changes in the cervical spine: Prospective 20-year follow-up study in asymptomatic subjects

BackgroundFew studies have characterized the development of Modic changes in the cervical spine over time. We evaluated Modic changes of the cervical spine that developed over a 20-year period in a healthy cohort, and sought to clarify the relationship between Modic changes and the development of clinical symptoms.MethodsFor this multicenter prospective cohort study, we recruited 193 subjects from an original cohort of asymptomatic volunteers who underwent MRI of the cervical spine between 1993 and 1996. Each cervical level from C2/3 to C7/T1 (total n = 1158 intervertebral levels) was assessed on current MRIs as normal or showing type 1, 2, or 3 Modic change, and we asked about symptoms related to the cervical spine. Relationships between the presence of Modic changes and patient characteristics, pre-existing disc degenerations or clinical symptoms were evaluated by logistic regression analysis.ResultsAfter 20-year follow-up, Modic changes affected 31 subjects (16.1%) at 47 intervertebral disc levels. Of these 47 intervertebral disc levels, type 2, found at 30 levels (63.8%), was the most frequent, followed by type 1 at 15 levels (31.9%) and type 3 at two levels (4.3%). The most frequent changes were observed at the C5/6 segment with type 2 Modic changes. The presence of Modic changes correlated with pre-existing posterior disc protrusion (odds ratio 3.31, 95% confidence interval 1.21–9.05) and neck pain (odds ratio 2.71, 95% confidence interval 1.08–6.80).ConclusionsIn the cervical spine over a 20-year period, type 2 Modic changes were most frequent at the C5/6 segment. The Modic changes were associated with pre-existing disc degeneration and neck pain but not with age, BMI, smoking, shoulder stiffness, arm pain or numbness.     

国人颈椎椎间盘解剖参数与常用人工椎间盘尺寸的比较

目的　分析临床上常用的人工椎间盘尺寸是否与国人颈椎椎体解剖尺寸相匹配,并据此提出适合国人的人工颈椎椎间盘设计方案。方法利用CT测量138例国内患者C_(2～7)椎体的相关解剖学数据(椎体终板前后径、横径,椎间隙高度,矢状角大小),并分别与4种常用人工椎间盘(Bryan、Prestige LP、Discover、Prodisc-C)的尺寸进行比较,分析人工椎间盘的尺寸是否与各个椎间隙尺寸相匹配,并计算不匹配率。结果 4种常用人工椎间盘中,在椎体终板前后径上与国人颈椎椎体解剖尺寸的不匹配率为15.22%(C_3/C_4节段,Prestige LP、Prodisc-C)至57.61%(C_6/C_7节段,Discover);在横径上的不匹配率为24.28%(C_3/C_4节段,Prodisc-C、Prestige LP)至94.93%(C_6/C_7节段,Bryan)。所有患者中,19.71%的椎体终板前后径大于最大人工椎间盘,52.17%的椎体终板最大横径大于最大人工椎间盘。除了因高度不固定而无法比较的Bryan人工椎间盘,其他人工椎间盘的最大高度均满足患者各节段的最大椎间隙高度,但39.13%的颈椎椎间隙高度小于最小的人工椎间盘高度。C_2/C_3、C_3/C_4、C_4/C_5、C_5/C_6、C_6/C_7节段平均矢状角分别为3.64°、4.51°、5.04°、5.15°、4.13°,纳入的4种人工椎间盘中只有Discover有固定的7°前凸角与之相符。结论目前临床上常用的人工椎间盘尺寸与国人椎体解剖数据存在较大差异,应设计更多的人工椎间盘尺寸来匹配国人颈椎。     

Herniated and spondylotic intervertebral discs of the human cervical spine: histological and immunohistological findings in 500 en bloc surgical samples. Laboratory investigation

OBJECT: In this paper the authors' goal was to identify histological and immunohistochemical differences between cervical disc hemrniation and spondylosis. METHODS: A total of 500 cervical intervertebral discs were excised from 364 patients: 198 patients with disc herniation and 166 patients with spondylosis. We examined en bloc samples of endplate-ligament-disc complexes. Types of herniation and graded degrees of disc degeneration on MR images were examined histologically and immunohistochemically. RESULTS: The herniated discs showed granulation tissue, newly developed blood vessels, and massive infiltration of CD68-positive macrophages, which surrounded the herniated tissue mainly in the ruptured outer layer of the anulus fibrosus. The vascular invasion was most significant in uncontained (extruded)-type herniated discs. Chondrocytes positive for matrix metalloproteinase (MMP)-3, tumor necrosis factor (TNF)-alpha, basic fibroblast growth factor (bFGF), and vascular endothelial growth factor (VEGF) were abundant in both herniated and spondylotic discs. Free nerve fibers, positive for nerve growth factor (NGF), neurofilament 68, growth-associated protein (GAP)-43, and substance P, were strongly apparent in and around the outer layer of uncontained (extruded)-type herniated discs, with enhanced expression of NGF. The authors observed that herniated discs showed more advanced degeneration in the outer layer of the anulus fibrosus around the granulation tissue than spondylotic discs. On the other hand, spondylotic discs showed more advanced degeneration in the cartilaginous endplate and inner layer of the anulus fibrosus than herniated discs. Spondylotic discs also had thicker bony endplates and expressed TNFalpha and MMP-3 more diffusely than herniated discs, especially in the inner layer of the anulus fibrosus. CONCLUSIONS: The authors' results indicate that herniated and spondylotic intervertebral discs undergo different degenerative processes. It is likely that TNFa, MMP-3, bFGF, and VEGF expression is upregulated via the herniated mass in the herniated intervertebral discs, but by nutritional impairment in the spondylotic discs. Macrophage accumulation around newly formed blood vessels in the herniated disc tissues seemed to be regulated by MMP-3 and TNFalpha expression, and both herniated and spondylotic discs exhibited marked neoangiogenesis associated with increased bFGF and VEGF expression. Nerve fibers were associated with NGF overexpression in the outer layer of the anulus fibrosus as well as in endothelial cells of the small blood vessels.     

颈椎椎间盘退变对终板结构生物力学特性的影响

目的研究颈椎椎间盘对终板结构生物力学特性的影响。方法50节颈椎标本,采用Nachemson椎间盘分级标准将标本分为4组,正常组(n=22)、Ⅰ度退变组(n=10)、Ⅱ度退变组(n=9)、Ⅲ度退变组(n=9),对每一终板平面上20个特定的测试点进行压缩实验,直径2mm的半球形压头以003mm/s的速度垂直于终板平面下压2mm,由所得的力─位移曲线计算出最大压缩力及刚度,采用单因素方差分析、析因分析、SNK检验及相关分析对实验数据进行统计学分析。结果颈椎椎间盘退变可导致颈椎终板最大压缩力及刚度的显著性减小(P<001),且存在负相关关系(分别为rs=-0429,P<0001;rs=-0244,P<0001);上终板随着椎间盘退变的加重终板平面中央承力逐渐变弱,外周承力逐渐增强,下终板的力学分布无明显改变。结论颈椎椎间盘退变是影响终板结构生物力学特性的重要因素,在进行颈椎前路融合术时应警惕由于椎间盘退变引起的“植入物沉陷”。     

Herniation of cervical intervertebral disc: immunohistochemical examination and measurement of nitric oxide production.

STUDY DESIGN: Surgically obtained cervical herniated intervertebral discs were examined histologically and immunohistochemically. The production of nitric oxide (NO) in the local tissue was examined using the electron spin resonance (ESR) method. OBJECTIVES: To investigate the local histologic and immunohistochemical changes in cervical disc herniation, including NO production, and to compare such changes with those in autopsy cases. SUMMARY OF BACKGROUND DATA: Very little is known about the histopathologic processes of cervical disc herniation. In addition, no information is available on the level of in vivo NO production in cervical disc herniation. METHODS: Thirty-six herniated cervical discs obtained from 31 patients were immunohistochemically examined for localization of blood vessels, matrix metalloproteinase (MMP)-3, and inducible NO synthetase (iNOS). We also compared the production of NO, measured by the ESR method, in eight specimens with that of five control discs obtained from fresh cadavers. RESULTS: The presence of herniated discs correlated with the degeneration of cartilaginous endplate and torn anulus fibrosus. Formation of new blood vessels around the herniated discs was detected, using von Willebrand factor antibody, in seven uncontained hernias and 20 contained hernias. Immunohistochemical studies showed the presence of cells positive for MMP-3 (chondrocytes), iNOS (chondrocytes and granulation tissue) in cervical disc hernias. ESR analysis showed a significantly higher NO production in herniated cervical discs than in disc samples of fresh cadavers. CONCLUSIONS: Herniated cervical intervertebral disc is characterized by the presence of an inflammatory process associated with neovascularization and increased expression of MMP-3. Production of NO was markedly high in both contained- and uncontained-type hernias.     

腰椎间盘退变性疾患下腰椎终板形态的MRI观察

【摘要】　目的：在MRI片上观察腰椎间盘退变患者下腰椎终板形态的分布规律,分析终板形态和椎间盘退变的关系。方法：回顾分析两组腰椎间盘退变性疾病患者的术前腰椎MRI,A组110例为单节段腰椎间盘突出症患者,B组35例为椎间盘源性腰痛患者。根据正中矢状面MRI T1像,将终板形态分为凹面、平坦、不规则三型;根据Pfirrmann法评定椎间盘退变程度并将Ⅰ～Ⅴ级分别计为1～5分;按Modic改变分级标准判定各节段终板有无Modic改变。分析下腰椎终板的形态特点及三种分型与椎间盘退变程度、Modic改变等的关系。结果：①435个下腰椎节段中,凹面型终板最多（215/435）,A组中占50.6％（167/330）,B组中占45.7％（48/105）,且主要分布于L3/4（108/215）、L4/5（83/215）节段;平坦型终板占29.0％（126/435）,并主要位于L5/S1节段（76/126）;不规则型终板最少（94/435）,A组中占23.0％（76/330）,B组中占17.1％（18/105）,也主要位于L5/S1节段（45/94）。②A组患者中,凹面型终板退变程度平均为3.31±0.81分,平坦型为3.66±0.64分,不规则型为4.16±0.67分,两两比较有显著差异（P＜0.05）;椎间盘突出节段以平坦型（37/110）和不规则型（43/110）终板占多数,无突出节段则以凹面型（137/220）终板占多数,差异有显著性（P＜0.05）;不规则型终板比凹面型和平坦型更容易伴发Modic改变,差异有显著性（P＜0.05）,凹面型和平坦型间无显著性差异（P＞0.05）。③B组患者中,凹面型终板的椎间盘退变程度平均为3.23±0.86分,平坦型为3.54±0.85分,不规则型为3.94±0.54分,仅凹面型和不规则型间差异有显著性（P＜0.05）。④相同终板形态时A组和B组椎间盘退变程度相比均无显著性差异（P＞0.05）。结论：终板形态与椎间盘退变、Modic改变之间有相关性。终板形态由凹面型到平坦型再到不规则型,腰椎间盘退变程度逐渐加重。影像学上终板形态改变在一定程度上反映了椎间盘退变的程度。     

斜外侧椎间融合在Modic改变伴终板硬化腰椎间盘退变治疗中的应用CSCD

目的:探讨Stand-alone斜外侧椎间融合(oblique lateral interbody fusion,OLIF)应用于Modic改变伴终板硬化的腰椎间盘退变治疗的可行性和临床效果。方法:回顾性分析2015年1月至2018年12月3家医疗中心收治的16例Modic改变伴终板硬化的腰椎间盘退变患者。其中男6例,女10例;年龄45~67(55.48±8.07)岁;病史36~240(82.40±47.68)个月。病变部位:L2,32例,L3,45例,L4,59例;均表现为慢性腰痛,伴下肢神经症状3例。采用单纯斜外侧腰椎椎间融合术治疗,术后对临床和影像学结果,以及并发症情况进行观察。结果:术中无血管、终板损伤和椎体骨折。切口长度(4.06±0.42)cm,手术时间(45.12±5.43)min,术中出血量(33.40±7.29)ml;术后72 h切口疼痛视觉模拟评分(visual analogue scale,VAS)为1.14±0.47。所有患者无切口皮肤坏死、愈合不良或感染;出现交感链损伤1例、左大腿前外侧疼痛并麻木2例、左侧髂腰肌无力1例,均为一过性损伤,并发症发生率为25%(4/16)。16例患者均获得随访,时间12~36(20.80±5.46)个月。术后椎间隙高度获得明显的恢复,随访过程中有轻度丢失。末次随访时腰椎冠状面和矢状面平衡均获得良好的改善。融合器无明显沉降或移位,均获得椎间融合。末次随访时日本骨科协会(Japanese Orthop-aedic Association,JOA)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)明显改善。结论:只要严格病例选择,充分的术前检查,采用Stand-alone OLIF治疗Modic改变伴终板硬化的腰椎间盘退变效果良好,临床优势明显,是较好的手术选择。     

颈椎椎间盘退行性改变与颈椎不稳

探讨颈椎椎间盘退性改变与颈椎不稳定的关系。方法对２６０例怀疑有颈椎疾患的者行Ｘ线及ＭＲＩ检查。在颈椎屈曲／伸展侧位片上测量椎体水平位及成象程度,并根据ＭＲＩＴ２加权像椎间盘信号强度判断其退变程度。结论颈椎的节段性不稳定是颈椎椎间盘退行改变的早期表现之一。