Posterior Cartilage Endplate Disruption on T1-weighted Magnetic Resonance Imaging as a Predictor for Postoperative Recurrence of Lumbar Disk Herniation.
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Abstract
Study design: A retrospective cohort study.
Objective: This study aimed to investigate the relationship between disruption of cartilage endplates and postoperative recurrence of lumber disk herniation (LDH) using preoperative T1-weighted magnetic resonance imaging (MRI-T1WI).
Summary of background data: Recurrence of LDH is a relatively common complication after discectomy. Although several risk factors have been identified, their predictive capability remains limited. Previous histologic studies reported that cartilage endplates were present in 85% of patients with recurrent LDH.
Methods: Patients with a single level of LDH who underwent open or microendoscopic discectomy were retrospectively reviewed. On the basis of preoperative sagittal MRI-T1WI, cartilage endplates were divided into anterior and posterior portions at the center of the disk and evaluated for discontinuity. Patient background characteristics, spinopelvic sagittal parameters, degrees of disk degeneration, and recurrence level were also evaluated.
Results: A total of 100 patients were included in this study (mean age, 50.5 years old; 41% female). Symptomatic recurrence of LDH occurred in 15 patients (15%). There were no significant differences in patient background characteristics (age, 46.9 vs. 51.2 years old; %female, 60% vs. 38%; smoking, 33% vs. 41%; diabetes mellitus, 27% vs. 29%) or spinopelvic parameters (PI, 44.1 vs. 47.0 degrees; PT, 16.8 vs. 19.4 degrees; SS, 27.3 vs. 27.6 degrees; LL, 37.7 vs. 33.7 degrees). In the recurrence group, MRI-T1WI showed a higher rate of cartilage endplate disruption in the posterior portion than in the no-recurrence group (73% vs. 34%, P=0.01). A multivariate analysis demonstrated that the disruption of the posterior cartilage endplate remained an independent predictor of recurrence.
Conclusions: Disruption in the posterior cartilage endplate on preoperative MRI-T1WI was closely associated with recurrence after LDH surgery. These results suggest that this MRI finding is a practical and useful predictor of LDH recurrence.
研究设计回顾性队列研究：本研究旨在利用术前 T1 加权磁共振成像（MRI-T1WI）研究软骨终板破坏与腰椎间盘突出症（LDH）术后复发之间的关系：背景数据摘要：LDH复发是椎间盘切除术后相对常见的并发症。虽然已确定了几个风险因素，但其预测能力仍然有限。以前的组织学研究报告显示，85%的复发性LDH患者存在软骨终板：方法：对接受开放或显微内窥镜椎间盘切除术的单层 LDH 患者进行回顾性研究。根据术前矢状位 MRI-T1WI，在椎间盘中心将软骨终板分为前部和后部，并评估其不连续性。此外，还对患者的背景特征、脊柱矢状面参数、椎间盘退化程度和复发水平进行了评估：本研究共纳入 100 名患者（平均年龄 50.5 岁，女性占 41%）。15名患者（15%）出现了LDH症状性复发。患者背景特征（年龄，46.9 岁 vs. 51.2 岁；女性比例，60% vs. 38%；吸烟比例，33% vs. 41%；糖尿病比例，27% vs. 29%）或脊柱骨盆参数（PI，44.1 度 vs. 47.0 度；PT，16.8 度 vs. 19.4 度；SS，27.3 度 vs. 27.6 度；LL，37.7 度 vs. 33.7 度）无明显差异。在复发组中，MRI-T1WI显示后部软骨终板破坏率高于未复发组（73% 对 34%，P=0.01）。多变量分析表明，后部软骨终板破坏仍是复发的独立预测因素：结论：术前磁共振成像-T1WI显示的后软骨终板破坏与LDH手术后的复发密切相关。这些结果表明，MRI的这一发现是预测LDH复发的一个实用且有用的指标：证据等级：三级
期刊介绍：
Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure.
Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.
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