Vertebral body MRI related to lumbar fusion results

被引：55

作者：

Buttermann G.R. ^{[1
,2
]}

Heithoff K.B. ^{[3
]}

Ogilvie J.W. ^{[4
,5
]}

Transfeldt E.E. ^{[4
,5
]}

Cohen M. ^{[5
]}

机构：

[1] Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN

[2] Midwest Spine Institute, Stillwater, MN 55082

[3] Center for Diagnostic Imaging, St. Louis Park, MN

[4] Department of Orthopaedic Surgery, University of Minnesota, Twin Cities Scoliosis and Spine Ctr., Minneapolis, MN

[5] Twin Cities Scoliosis and Spine Ctr., Minneapolis, MN

来源：

European Spine Journal | 1997年 / 6卷 / 2期

关键词：

Disc degeneration; Endplate; Fusion; MRI; Pain;

D O I：

10.1007/BF01358743

中图分类号：

学科分类号：

摘要：

The evaluation of continued pain after a technically successful posterolateral lumbar spine fusion is often challenging. Although the intervertebral disc is often a source of low back pain, abnormal endplates may also be a focus of pain, and possibly a source of continued pain after a posterolateral fusion. MRI allows noninvasive evaluation for disc degeneration, as well as for abnormal endplates and adjacent vertebral body marrow. Previous studies have found inflammatory marrow changes, adjacent to abnormal endplates, associated with disc degeneration in low back pain patients. In this study, preoperative MRI scans in 89 posterolateral lumbar fusion patients were reviewed, by an independent radiologist, to determine whether vertebral body marrow changes adjacent to the endplates were related to contined pain. Independent chart review and follow-up telephone interview of all patients at a 4-year follow-up (mean) formed the basis for the clinical results. Vertebral body MRI signals consistent with inflammatory or fatty changes were found in 38% of patients, and always occurred adjacent to a degenerated disc. Inflammatory MRI vertebral body changes were significantly related to continued low back pain at P = 0.03. We conclude that posterolateral lumbar fusion has a less predictable result for the subset of degenerative disc patients with abnormal endplates and associated marrow inflammation. More research is needed to determine the biological and biomechanical effects of a posterolateral fusion upon the endplate within the fused segments. If indeed further study supports the hypothesis that abnormal endplates associated with inflammation are a source of pain, then treating the endplates directly by anterior fusion may be a preferred treatment for this subset of degenerative patients.

引用

页码：115 / 120

页数：5

共 36 条

[1] Ahmed M., Bjurholm A., Kreicbergs A., Schultzberg M., SP- and CGRP-immunoreactivc nerve fibers in the rat lumbar spine, Neuroorthopedics, 12, pp. 19-28, (1991)
[2] Ahmed M., Bjurholm A., Kreiebergs A., Schultzberg M., Neuropeptide Y, tyrosine hydroxylase and vasoactive intestinal polypeptide-immunoreactive nerve fibers in the vertebral bodies, discs, dura mater, and spinal ligaments of the rat lumbar spine, Spine, 18, pp. 268-273, (1993)
[3] Blumenthal S.L., Baker J., Dossett A., Selby D.K., The role of anterior lumbar fusion in internal disc disruption, Spine, 13, pp. 566-569, (1988)
[4] Bogduk N., The innervation of the intervertebral discs, The Biology of the Intervertebral Disc, pp. 135-149, (1988)
[5] Buttermann G.R., Hunt A.F., Garvey T.A., Ogilvie J.W., Transfeldt E.E., Bradford D.S., Boachie-Adjei O., Results of lumbar fusion related to diagnosis, Ninth Annual Meeting of the North American Spine Society, (1994)
[6] Crock H.V., Internal disc disruption - A challenge to disc prolapse fifty years on, Spine, 11, pp. 650-653, (1986)
[7] De Roos A., Kressel H., Spritzer C., Dalinka M., MR imaging of marrow changes adjacent to endplates in degenerative disk disease, Am J Radiol, 149, pp. 531-534, (1987)
[8] Fedewa M., Schendel M.J., Buttermann G.R., Transfeldt E.E., In vitro spinal endplate loading before and after fusion, Forty-first Annual Meeting of the Orthopaedic Research Society, (1995)
[9] Feffer H.L., Treatment of low-back and sciatic pain by the injection of hydrocortisone into degenerated intervertebral discs, J Bone Joint Surg [Am], 38, pp. 585-592, (1956)
[10] Graham C.E., Chemonucleolysis: A double blind study comparing chemonucleolysis with intra-discal hydrocortisone in the treatment of backache and sciatica, Clin Orthop, 117, pp. 179-192, (1976)

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