腰椎盘再的放射预测器需要重复切割或融合 - 一个匹配的回顾性队列分析
Joshua L Golubovsky1, Ben J Gu1, Elie Massaad1
1Department of Neurosurgery, Hospitals of the University of Pennsylvania, Philadelphia, PA, United States.
概括
频发性腰椎间盘 (rLDH) 的风险随着伴随性疾病负担的增加,端板变化和面部关节病变而增加. 这些通过MRI识别的因素有助于患者咨询和腰椎切除术的手术规划.
科学领域:
- 神经外科和骨架脊椎外科手术
- 放射学和医学成像学 医学成像学
背景情况:
- 腰椎间盘切除术是症状性腰椎间盘 (LDH) 的标准,但需要重新手术的复发性LDH (rLDH) 在3-18%的患者中发生.
- 术前放射性参数对rLDH风险的贡献尚不清楚,尽管研究了人口统计学和临床因素.
研究的目的:
- 为了评估手术前的MRI发现,在经历单级腰椎切除术的患者.
- 为了确定与手术性rLDH相关的综合临床和放射性因素,在初级椎间盘切除术后.
主要方法:
- 对接受初级,单级腰部微分切除术的成年患者进行了回顾性队列研究.
- 分析包括人口统计学,并发症和手术前MRI参数 (椎形态,磁盘退化,端板变化,面部关节病变).
- 用多变量Cox比例危险模型和ROC曲线来确定复发风险因素.
主要成果:
- 在2608名患者中,4.9% (129) 患者需要在3年内因rLDH重新手术.
- 对于rLDH的独立风险因素包括Modic变化 (HR 1.86),更高的面部退行指数 (HR 1.43/级),更高的查尔森并发症指数 (HR 1.21/点),年轻年龄 (HR 0.98/年) 和男性性别 (HR 1.58).
- 与单独的临床因素相比,放射性因素提高了预测精度 (AUC).
结论:
- 增加的并发症负担,退行性末变化 (Modic) 和面部关节病是手术性rLDH的重要预测因素.
- 这些发现对于改善腰椎切除术患者咨询和手术规划至关重要.
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