| Objective: Studies on the correlation between lumbar degeneration and sagittal parameters have been reported at home and abroad.However,similar studies on lumbar degeneration with MODIC change are very limited.Therefore,this study used a propensity score matching method(PSM)to analyze the relationship between MODIC change and lumbar-related sagittal parameters in lumbar degenerative diseases with or without MODIC change.Methods: A total of 318 patients with lumbar degenerative diseases with or without Modic changes diagnosed by magnetic resonance imaging technology in the spine surgery department of our hospital were collected,of whom 30 patients were not included in the study due to incomplete data.According to the presence or absence of MODIC change,the 288 patients were divided into the MODIC change group(MC group)(n = 105)and lumbar degeneration group(DD group)(n = 183).The MC group was divided into three subgroups,namely MC1 group(29 cases),MC2 group(45 cases),and MC3 group(31 cases),according to the signal value of T1 and T2-weighted items on MRI of the vertebrae.Lumbar degeneration group(183 cases).MRI and X-rays of the patients were independently evaluated using the software Surgimap(Nemaris 2.2.15,USA).Lumbar lordosis Angle(LL),sacral inclination Angle(S1s),intervertebral Angle [IVA(L3/4),IVA(L4/5),IVA(L5/S1)],intervertebral height index [IHI(L3/4),IHI(L4/5),IHI(L5/S1)] and endplate concave Angle [ECA(L3/4 U),ECA(L3/4 L),ECA(L5/ S1L),ECA(L5/ S1L)] were measured as observation indexes.Because between two groups in gender,age,height,and weight,etc.General data statistical differences(P < 0.05),and the DD set the number of cases was about 1.74 times the MC group the number of cases(183/105),far less than the control group of propensity score matching law requires four times more than the number of cases is greater than the experimental group,as a result,using propensity score matching method will be the MC each subgroup(MC1/MC2/MC3)and DD group match analysis respectively,to eliminate bias,grouping approximate randomization effect,with the proportion of 1:1 and 0.05 caliper distance matching.Finally,the matched new samples were used for statistical analysis.Measurement data were expressed as mean ± standard deviation((?)±s),t-test was used for comparison between the two groups,and the chi-square test or Fisher test was used for comparison of numerical data between the two groups.P<0.05 was considered statistically significant.Results: 1.MC1 group and DD group: after propensity score matching,the remaining cases between the two groups were 28 cases in the MC1 group and 28 cases in the DD group;A total of 156 cases with confounding factors were excluded,of which only one case in the MC1 group was not matched to a suitable study object.The remaining 28 pairs of patients were included in the study analysis,and the results showed that all the baseline data between the two groups were not statistically significant(P>0.05),and the two groups could be compared.The L3/4 lumbar height MC1 group vs DD group [(20.08±3.43)mm vs(28.44±2.68)mm] and the L5/S1 lumbar height MC1 group vs DD group [(29.61±4.04)mm vs(32.94±5.14)mm]showed statistically significant differences in the L3/4 and L5/S1 intervertebral heights between the two groups(P<0.05),and the L3/4 and L5/S1 intervertebral heights in the MC1 group were lower than those in the DD group.In addition,the average Angle of upper endplate concave Angle MC1 group vs DD group in L3/4 was [(159.88±4.95)° vs(166.49±6.96)°],and the average Angle of lower endplate concave Angle MC1 group vs DD group in L4/5 was [(167.82±7.39)° vs(173.98±4.20)°],with statistical significance between the two groups(P<0.05).Similarly,the average Angle of L3/4U and L4/5L in the MC1 group was lower than that in the DD group.2.MC2 group and DD group: After propensity score matching,the remaining 43 pairs of cases were included in the final analysis and study,362 cases were excluded,of which 2 cases in the MC2 group were not matched to the appropriate research object.Finally,43 pairs of patients were included in the study,and the results showed that the baseline data between the two groups were not statistically significant(P>0.05),and the two groups were comparable.The mean angle of lumbar lordosis Angle MC2 group vs DD group was [(31.18±11.98)° vs(39.29±10.06)°],and the mean Angle of sacral inclination Angle MC2 group vs DD group was[(29.89±8.20)° vs(34.87±7.12)°],which was statistically significant between the two groups(P=0.00<0.05),and the mean Angle of MC2 group was lower than that of DD group.The L3/4 intervertebral height MC2 group vs DD group [(24.70±5.65)mm vs(28.85±2.72)mm] and the L4/5intervertebral height MC2 group vs DD group [(26.77±6.21)mm vs(31.22±5.62)mm] showed statistically significant differences in the L3/4and L4/5 intervertebral height between the two groups(P=0.00<0.05).In terms of the intervertebral height,the parameters of the MC2 group were all lower than those of the DD group.In addition,the average Angle of the L3/4 upper endplate concave Angle MC2 group vs the DD group was[(159.68±8.10)° vs(166.70±6.64)°],the average Angle of the L3/4 lower endplate concave Angle MC2 group vs the DD group was [(162.06±10.38)°vs(173.59±3.98)°],the average Angle of the L4/5 upper endplate concave Angle MC2 group vs the DD group was [(159.77±13.16)° vs(167.13±7.09)°],and the L4/5 lower endplate concave Angle MC2 group The average Angle of VS DD group was [(165.11±9.63)° vs(173.56±4.44)°],and there was statistical significance in the upper/lower endplate concave Angle of L3/4 and L4/5 between the two groups(P<0.05),and the average upper/lower endplate concave Angle of MC2 group was less than that of DD group.Other sagittal parameters of lumbar imaging showed no statistical significance(P>0.05).3.MC3 group and DD group:After the propensity score matching,all cases in the MC3 group were matched to the study object from the DD group.Therefore,the final 31 pairs of cases were included in the study for analysis,and the results showed that the baseline data between the two groups were not statistically significant(P>0.05),and the two groups were comparable.The average Angle of lumbar lordosis in the MC3 group vs DD group was[(34.59±11.33)° vs(40.17±9.10)°],and there was statistical significance between the two groups(P=0.04<0.05),and the average Angle of the MC3 group was lower than that of DD group.L3/4 intervertebral height MC3 group vs DD group [(23.80±1.62)mm vs(28.52±2.66)mm],there was statistical significance between the two groups(P=0.00<0.05).Similarly,the L3/4 intervertebral height MC3 group was lower than the DD group.In addition,the average Angle of the L3/4 upper endplate concave Angle MC3 group vs DD group was [(153.00±3.93)° vs(166.04±6.50)°],the average Angle of the L3/4 lower endplate concave Angle MC3 group vs DD group was [(145.06±12.42)° vs(173.41±3.38)°],and the average Angle of the L4/5 lower endplate concave Angle MC3 group vs DD group was[(163.21±9.80)° vs(173.95±3.81)°].There were statistically significant differences between the two groups in the concave Angle of L3/4 upperend plate,L3/4 lower endplate,and L4/5 lower endplate(P=0.00<0.05).Conclusions: This study showed that type 2 Modic changes were the most common,followed by type 3 Modic changes,followed by type 1 Modic changes,and all three types of Modic changes were more likely to occur in the L5/S1 segment.Compared with simple lumbar vertebral degeneration,type 1 Modic changes of intervertebral height(L3/4,L5/S1)is relatively narrow,the endplate and vertebral body lesions(L3/4 U,L4/5 L)is relatively serious,type 2 Modic changes of intervertebral Angle,sacral slope Angle is relatively narrow,the decrease of the endplate concave Angle and vertebral body damage is bigger,the relationship between the three types of Modic changes in L3/4 intervertebral Angle and the decrease of the endplate concave Angle and the relationship between vertebral body damage is bigger. |
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