Analiza degeneracije diska magnetskom rezonancijom u adolescenata s idiopatskom skoliozom : moguća povezanost s bolnom kralješnicom

Žutelija Fattorini, Matija (2017) Analiza degeneracije diska magnetskom rezonancijom u adolescenata s idiopatskom skoliozom : moguća povezanost s bolnom kralješnicom. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Scoliosis is the most common deformity of the spine, and the incidence of back pain in AIS ranges from 32% - 85%. Although it is considered that AIS can cause pain in the spine, this connection with regard to the scientific evidence is not entirely clear. Aim: The aim of this study was to determine the relationship of morphological changes of intervertebral segments analyzed by MRI in patients with AIS and pain, and also its impact on patients functional status and quality of life. Method: The study included 120 patients diagnosed with AIS based on radiographic examination. Patients underwent MRI (1.5-T) of the thoracic and lumbar spine. SN were detected, and the degree of disc degeneration was classified using the Pfirrmann grading system. Patients filled out VAS, the ODI for back pain and questionnaire SRS-22r. Results: The incidence of pain in AIS is 68.3%, and the largest number of participants experienced mild pain. Statistically significant association of DD in lumbar spine with the occurrence of pain was shown, but only at the fourth degree of DD according to Pfirrmann classification. The incidence of SN were 35%. Patients with SN were 4 times more likely to have pain, and 3,5 times higher intensity of pain scaled according to VAS. In addition, a distinct correlation with DD classified according to Pfirrmann that is more pronounced at high-grade DD was found. There is an independent connection of the female sex with poorer functional status, measured by the ODI, and quality of life, measured by the questionnaire SRS-22r. Conclusion: Morphological changes of the intervertebral disc like SN and DD can be one of the factors that cause back pain in AIS. It should be remembered that the presence of DD, especially if it is low-grade, is not enough to confirm the etiology of pain. We also found a distinct correlation of SN and high-grade DD, and a significantly higher intensity of pain in patients with SN. The association between SN and DD may stress the importance of the endplate on the pathogenesis of the degenerative changes in the intervertebral disc.

Abstract in Croatian

Skolioza je najčešći deformitet kralješnice, a učestalost bolova u kralješnici kod AIS kreće se od 32%-85%. Iako se smatra da AIS može biti uzrokom boli u kralješnici, ta povezanost obzirom na znanstvene dokaze nije posve jasna. Cilj istraživanja: Cilj istraživanja bio je utvrditi povezanost morfoloških promjena intervertebralnog segmenta analiziranih MRI u bolesnika s AIS i boli te utjecaj na funkcionalni status i kvalitetu života. Metode: U istraživanje je uključeno 120 bolesnika kojima je temeljem radiološke obrade postavljena dijagnoza AIS. Učinjena je MRI (1,5-T) torakalne i lumbalne kralješnice, utvrđena je prisutnost SH, a stupanj DD klasificiran je po Pfirrmannu. Bolesnici su ispunili VAS, ODI i upitnik SRS-22r. Rezultati: Incidencija boli u bolesnika s AIS je 68,3%, a najveći broj ispitanika je imao blagu bol. Uočena je statistički značajna povezanost DD lumbalne kralješnice s pojavom boli, ali samo kod visokog četvrtog stupnja DD klasifikacijom po Pfirrmannu. Incidencija SH bila je 35%, a ispitanici sa SH imali su 4 puta veće izglede za bol i 3,5 puta viši intezitet boli mjeren VAS-om. Osim toga nađena je izrazita povezanost SH i DD klasifikacijom po Pfirrmannu posebno kada je DD visokog stupnja. Postoji neovisna povezanost ženskog spola sa slabijim funkcionalnim statusom mjerenim ODI te s kvalitetom života mjerenom upitnikom SRS-22r. Zaključak: morfološke promjene intervertebralnog diska u prvom redu SH i DD mogu biti čimbenici koji uzrokuju križobolju kod AIS. Svakako treba imati na umu da prisutnost DD posebno ako je niskog stupnja nije dovoljna u potvrdi etiologije boli. Također smo ustanovili izrazitu povezanost SH i DD, posebno kada je DD visokog stupnja te značajno viši intezitet boli na VAS. Povezanost SH i DD govori u prilog važnosti pokrovne ploče kralješka u patofiziološkim promjenama intervertebralnog segmenta koje vode razvoju degenerativne bolesti diska.

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