| Background:Nowadays,the trend of aging population is more and more obvious.Accompanying the aging of the population is the increasing incidence of degenerative diseases of the lumbar spine,which makes the risk of degenerative diseases of the lumbar spine in the elderly become higher and higher.Among them,the lumbar disc herniation(LDH)is one of the most typical degenerative diseases of the lumbar spine in the elderly,and it is also the most common degenerative disease of the lumbar spine.The concept of lumbar disc herniation refers to the fact that the various components of the lumbar intervertebral disc(nucleus pulposus,annulus fibrosus and cartilage endplate),especially the nucleus pulposus tissue,undergo different degrees of degenerative changes.Due to the influence of external forces,the annulus fibrosis of the lumbar intervertebral disc is partially or completely ruptured,and the nucleus pulposus tissue protrudes from the rupture of the annulus to the posterior or spinal canal,causing different degrees of stimulation or compression of the adjacent spinal nerve roots.As a result,patients will have low back pain,pain in one or both lower limbs,numbness and paresthesia,serious patients will have cauda equina nerve injury and a series of clinical symptoms of syndrome.The most common lumbar segments are L4/5 and L5/S1,accounting for about 95%.There are many factors leading to the occurrence and development of lumbar disc herniation,such as lumbar trauma,incorrect lumbar posture,lumbosacral congenital abnormalities,genetic susceptibility factors and occupational risk factors.For the elderly,suffering from lumbar disc herniation seriously affects their quality of life,and at the same time causes a certain financial burden and family pressure.Therefore,early effective prevention,early detection and clear diagnosis and timely treatment and intervention are crucial important.Previous studies on the risk factors of lumbar disc herniation mostly focused on general conditions such as age,body mass index,environmental factors and lifestyle habits.There is a relatively lack of research on risk factors based on imaging measurements,especially the lack of research on elderly patients with lumbar disc herniation as the research object.Objective:The imaging measurement method was used to obtain the parameter data of the lumbar intervertebral height and the facet joint angle,and analyze the change trend and characteristics of the above-mentioned imaging measurement parameters,as well as the correlation between the severity of lumbar disc herniation in elderly patients and the above-mentioned imaging measurement parameters.Methods:A retrospective study was performed on the lumbar CT imaging data of elderly patients with L4/5 segment LDH and healthy elderly undergoing health examinations in Qilu Hospital of Shandong University from January 2016 to January 2019.114 LDH(L4/5)elderly patients including 59 males and 55 females with an average age of 71.63 ± 5.93 years old(65～91 years old)and 89 healthy elderly including 51 males and 38 females with an average age of 72.35±5.61 years old(65～86 years old)were enrolled in this study.MSU classification was used to evaluate the severity of LDH,and lumbar CT sagittal and axial reconstruction images were used to measure intervertebral height(IH)of each segment of L1-S1 and facet joint angle(FJA)of L4/5 segment in two groups,respectively.Statistical methods were used to analyze the changing trends and characteristics of imaging measurement parameters of lumbar disc herniation in elderly patients,as well as the correlation between the severity of lumbar disc herniation in elderly patients and the above-mentioned imaging measurement parameters.Results:In LDH group,IH of L1/2,L2/3,L3/4,L4/5 and L5/S1 segments were 5.95 ±1.19 mm,7.12 ± 1.42 mm,9.61± 1.36 mm,10.10 ± 1.89 mm and 9.66± 2.23 mm.In healthy group,IH of L1/2,L2/3,L3/4,L4/5 and L5/S1 segments were 5.49± 1.09 mm,6.30 ± 1.41 mm,8.58 ± 1.81 mm,9.16 ± 2.00 mm and 8.32 ± 2.17 mm.IH of each segment in LDH group was higher than that in healthy group(P<0.05).There was no trend relationship between IH of each segment and age in LDH group(P>0.05).Only IH of L4/5 segment in healthy group decreased with increase of age(P=0.008).FJA of L4/5 segment in LDH group and healthy group were 53.56°± 7.18° and 44.29°±5.32° respectively,and FJA of L4/5 segment in LDH group was larger than that in healthy group(P<0.001).There was no trend relationship between FJA and age in two groups(P>0.05).In LDH group,IH of Ll-S1 segments and FJA of L4/5 segment showed an increasing trend with increase of the degree of LDH(P<0.05).When IH≥8.72mm,the risk of MSU type 2 and above LDH increased by 3.24 times(P=0.003);when FJA≥47.75°,the risk of MSU type 2 and above LDH increased by 7.35 times(P<0.001);and when IH≥ 8.72mm and FJA≥ 47.75°,the risk of MSU type 2 and above LDH increased most significantly(P=0.001).Conclusions:Elderly patients with IH≥9mm and FJA≥48°are more likely to develop L4/5 segment LDH.Identification of key radiographic risk factors for LDH in elderly patients might help the early diagnosis and treatment. |
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