Servikal disk hernisi tanılı hastalarda d vitamini düzeyleri, paraspinal kas kitlesi, disk dejenerasyonu, faset tropizmi, akut faz reaktanları ve klinik bulgular arasındaki ilişkinin değerlendirilmesi
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Tarih
2023
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Kırıkkale Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş: Yağda çözünen bir vitamin olan vitamin D güneş ışığının etkisiyle endojen olarak üretilebilen steroller grubundandır. Başlıca kalsiyum metabolizması, fosfor metabolizması ve kemik mineralizasyonu üzerinde etkisi vardır. Spinal kord, sinir kökleri ve dorsal kök gangliyonunda vitamin D reseptörleri tanımlanmıştır, vitamin D reseptörünün genetik polimorfizminin disk herniasyonu ve disk dejenerasyonuyla ilişkili olduğu gösterilmiştir. Servikal disk herniasyonu etiyolojisi tam olarak bilinmemesine rağmen, vitamin D eksikliğinin disk herniasyonlarıyla ilişkili olduğu ileri sürülmüştür. Bu çalışmada servikal disk hernisi tanılı hastalarda vitamin D seviyesi ile paraspinal kas kitlesi, disk dejenerasyonu, disk herniasyonu şiddeti, faset tropizmi, akut faz reaktanları ve klinik bulgularla ilişkisinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Servikal MR görüntüsü olan 100 hasta çalışmaya dahil edildi. Hastaların ağrı seviyesi Vizüel Analog Skala, Boyun Disabilite İndeksi (BDİ) ve Bournemouth Boyun Anketi (BBA) ile değerlendirildi. MR görüntülerinden disk dejenerasyonu varlığı ve şiddeti (Pfirrmann evresi), multifidus kas çapı, disk herniasyonu şiddeti, faset açıları ve faset tropizmi değerlendirildi. Hasta veri tabanından vitamin D, C-reaktif protein (CRP), Albumin/CRP oranı, nötrofil/lenfosit oranı ve platelet/lenfosit oranı elde edildi. Hastalar vitamin D seviyesine göre ikiye ayrıldı: Vitamin D seviyesi normal olanlar (>20 ng/ml) ve vitamin D seviyesi eksik olanlar (<20 ng/ml). Bulgular: Hastaların ortalama yaşı 48,7 ± 9,5 yıl idi. Kadın/erkek oranı 1,8/1 idi. Hastaların %64'ünde vitamin D eksikliği olduğu saptandı. Vitamin D seviyesi düşük olan hastalarda VAS-gece (p<0,001), VAS-gündüz (p<0,001), BDİ (p<0,001) ve BBA (p<0,001) skoru vitamin D seviyesi normal olanlardan daha yüksekti. Vitamin D seviyesi düşük ve normal olan hastalar arasında üst ekstremite kas güçleri arasında farklılık yoktu. Vitamin D seviyesi düşük olan olgularda tüm seviyelerde Pfirrmann evresiyle değerlendirilen disk dejenerasyonu şiddeti ve servikal disk herniasyonu şiddeti daha yüksekti (tüm analizlerde p<0,05). Benzer şekilde, multifidus kas çapları vitamin D eksikliği olan hastalarda daha küçüktü. Vitamin D eksikliği olanlarda faset tropizm sıklığı daha fazla idi (p=0,024). Ancak vitamin D seviyesi grupları arasında CRP (p=0,371), albümin/CRP oranı (p=0,349), nötrofil/lenfosit oranı (p=0,618) ve platelet/lenfosit oranı (p=0,980) benzerdi. Sonuç: Çalışmamızda servikal disk herniasyonu olan hastalarda vitamin D eksikliği ile disk dejenerasyonu, paraspinal kas çapları, disk herniasyonu şiddeti ve faset tropizm sıklığının ilişkili olduğu gösterildi. Vitamin D servikal disk herniasyonu patogenezinde önemli rol oynamaktadır. Servikal disk herniasyonlarının tedavisinde ve önlenmesinde vitamin D seviyeleri dikkate alınmalıdır. Anahtar kelimeler: Servikal disk herniation, disk hastalığı, vitamin D, vitamin D eksikliği
Introduction: Vitamin D, a fat-soluble vitamin, is a group of sterols which is synthesised in response to sunlight, endogenously. The major key effects are on calcium metabolism, phosphorus metabolism, and bone mineralization, However, beyond calcium metabolism, vitamin D also has functions on the musculoskeletal system. Vitamin D receptors have been identified in the spinal cord, nerve roots, and dorsal root ganglia, its genetic polymorphism association with the development of disc degeneration and herniation has been documented. Although the etiology of cervical disc disease is unknown, it has been suggested that vitamin D deficiency was positively associated with disk herniations. The aim of this study is to evaluate the relationship between vitamin D with paraspinal muscle mass, disc degeneration, severity of disc herniation, facet tropism, acute phase reactants and clinical findings in patients with cervical disc herniation. Material and methods: A hundred patients diagnosed with cervical disc herniation by cervical MR imaging were included in the study. Pain levels of the patients were evaluated with the Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Bournemouth Neck Questionnaire (BNQ). Presence and severity of disc degeneration (Pfirrmann staging), measurement of multifidus muscle diameters, severity of disc herniation, facet angles and facet tropism were evaluated in MR images. Vitamin D, C-reactive protein (CRP), Albumin/CRP ratio, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio were obtained from the hospital database. Patients were divided into two groups as normal (>20 ng/ml) or vitamin D deficiency (<20 ng/ml) according to serum 25 (OH)D level. Results: The mean age of the patients was 48.7 ± 9.5. The female/male ratio in the study was 1.8/1. Vitamin D deficiency was present in 64% of the patients. The patients with low vitamin D levels had higher VAS-night (p<0.001), VAS-day (p<0.001), BDI (p<0.001) and BBA scores (p<0.001) than patients with normal vitamin D levels. Upper extremity muscle strengths were similar between patients with normal and low vitamin D levels. Patients with low vitamin D levels had higher severity of disc degeneration assessed by Pfirrmann stage, and had higher severity of disc herniation at all cervical levels (p<0.05 in all analyzes). Similarly, multifidus muscle diameters were smaller in patients with vitamin D deficiency. The frequency of facet tropism was higher in those with vitamin D deficiency (p=0.024). However, CRP (p=0.371), albumin/CRP ratio (p=0.349), neutrophil/lymphocyte ratio (p=0.618), platelet/lymphocyte ratio (p=0.980) were similar between patients with normal and deficient vitamin D levels. Conclusion: Our study demonstrates that vitamin D deficiency was associated with disc degeneration, diameter of paraspinal muscle, severity of herniation and frequency of facet tropism in patients with cervical disk herniation. Vitamin D plays an important role in the pathogenesis of cervical disc herniation. Vitamin D level should be considered in the treatment and prevention of cervical disc herniation. Key words: Cervical disc herniation, disc disease, vitamin D, deficiency of vitamin D
Introduction: Vitamin D, a fat-soluble vitamin, is a group of sterols which is synthesised in response to sunlight, endogenously. The major key effects are on calcium metabolism, phosphorus metabolism, and bone mineralization, However, beyond calcium metabolism, vitamin D also has functions on the musculoskeletal system. Vitamin D receptors have been identified in the spinal cord, nerve roots, and dorsal root ganglia, its genetic polymorphism association with the development of disc degeneration and herniation has been documented. Although the etiology of cervical disc disease is unknown, it has been suggested that vitamin D deficiency was positively associated with disk herniations. The aim of this study is to evaluate the relationship between vitamin D with paraspinal muscle mass, disc degeneration, severity of disc herniation, facet tropism, acute phase reactants and clinical findings in patients with cervical disc herniation. Material and methods: A hundred patients diagnosed with cervical disc herniation by cervical MR imaging were included in the study. Pain levels of the patients were evaluated with the Visual Analogue Scale (VAS), Neck Disability Index (NDI), and Bournemouth Neck Questionnaire (BNQ). Presence and severity of disc degeneration (Pfirrmann staging), measurement of multifidus muscle diameters, severity of disc herniation, facet angles and facet tropism were evaluated in MR images. Vitamin D, C-reactive protein (CRP), Albumin/CRP ratio, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio were obtained from the hospital database. Patients were divided into two groups as normal (>20 ng/ml) or vitamin D deficiency (<20 ng/ml) according to serum 25 (OH)D level. Results: The mean age of the patients was 48.7 ± 9.5. The female/male ratio in the study was 1.8/1. Vitamin D deficiency was present in 64% of the patients. The patients with low vitamin D levels had higher VAS-night (p<0.001), VAS-day (p<0.001), BDI (p<0.001) and BBA scores (p<0.001) than patients with normal vitamin D levels. Upper extremity muscle strengths were similar between patients with normal and low vitamin D levels. Patients with low vitamin D levels had higher severity of disc degeneration assessed by Pfirrmann stage, and had higher severity of disc herniation at all cervical levels (p<0.05 in all analyzes). Similarly, multifidus muscle diameters were smaller in patients with vitamin D deficiency. The frequency of facet tropism was higher in those with vitamin D deficiency (p=0.024). However, CRP (p=0.371), albumin/CRP ratio (p=0.349), neutrophil/lymphocyte ratio (p=0.618), platelet/lymphocyte ratio (p=0.980) were similar between patients with normal and deficient vitamin D levels. Conclusion: Our study demonstrates that vitamin D deficiency was associated with disc degeneration, diameter of paraspinal muscle, severity of herniation and frequency of facet tropism in patients with cervical disk herniation. Vitamin D plays an important role in the pathogenesis of cervical disc herniation. Vitamin D level should be considered in the treatment and prevention of cervical disc herniation. Key words: Cervical disc herniation, disc disease, vitamin D, deficiency of vitamin D
Açıklama
Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Ana Bilim Dalı
Anahtar Kelimeler
Fiziksel Tıp ve Rehabilitasyon, Physical Medicine and Rehabilitation
