Atypical patterns of spinal segment degeneration in patients with abdominal aortic aneurysms.
Eur Spine J
; 32(1): 8-19, 2023 01.
Article
en En
| MEDLINE
| ID: mdl-35835893
ABSTRACT
PURPOSE:
Abdominal aortic aneurysms (AAAs) affect the vascular perfusion of the lumbar spine. The treatment of AAAs with endovascular aortic aneurysm repair (EVAR) completely occludes the direct vascular supply to the lumbar spine. We hypothesized that patients with AAA who undergo EVAR show a different pattern of spinal degeneration than individuals without AAA.METHODS:
In this retrospective institutional review board-approved study, 100 randomly selected patients with AAA who underwent EVAR with computed tomography (CT) scans between 2005 and 2017 were compared with age- and gender-matched controls without AAA. In addition, long-term follow-up CT images (> 6 months before EVAR, at the time of EVAR, and > 12 months after EVAR) of the patients were analysed to compare the progression of degeneration from before to after EVAR. Degeneration scores, lumbar levels with the most severe degeneration, and lumbar levels with progressive degeneration were analysed in all CT images. Fisher's exact test, Wilcoxon signed-rank test, and Mann-Whitney U test were performed for statistical analyses.RESULTS:
Compared with the control group (n = 94), the most severe degeneration was more commonly detected in the mid-lumbar area in the patient group (n = 100, p = 0.016), with significantly more endplate erosions being detected in the lumbar spine (p = 0.015). However, EVAR did not result in significant additional acceleration of the degenerative process in the long-term follow-up analysis (n = 51).CONCLUSION:
AAA is associated with atypical, more cranially located spinal degradation, particularly in the mid-lumbar segments; however, EVAR does not seem to additionally accelerate the degenerative process. This observation underlines the importance of disc and endplate vascularization in the pathomechanism of spinal degeneration. LEVEL OF EVIDENCE I Diagnostic individual cross-sectional studies with consistently applied reference standard and blinding.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Aneurisma de la Aorta Abdominal
/
Procedimientos Endovasculares
Tipo de estudio:
Observational_studies
/
Risk_factors_studies
Límite:
Humans
Idioma:
En
Año:
2023
Tipo del documento:
Article