Defects of the vertebral end plate: implications for disc degeneration depend on size

Zehra, Uruj; Flower, Luke; Robson-Brown, K; Adams, Michael A.; Dolan, Patricia

doi:10.1016/j.spinee.2017.01.007

Cited by 33 publications

(45 citation statements)

References 61 publications

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“…The inferior endplates relative to discs are thinner and are supported by less trabecular bone explaining the higher prevalence of inferior endplate defects in the current study. Interestingly the depth of the endplate defect was greater in superior endplates this finding was consistent with a previous study and is probably due to the marked concavity observed in these endplates with aging …”

Section: Discussionsupporting

confidence: 92%

“…In our study, male endplates were seen to be slightly more affected as compared to females though significant difference could not be achieved which is consistent with previous studies . However, we also observed that females have wider endplate defects and higher cumulative endplate defect scores, possibly a result of osteoporotic changes influencing female bones earlier than males .…”

Section: Discussionsupporting

confidence: 87%

“…The current study only measured and noted those defects having distinct margins, and calcification of the endplate was also not included within the lesion of the endplates. However this insignificant relationship with age is consistent with the findings of a previous micro CT study performed on cadaveric human samples . These results are highly suggestive of the fact that other factors, such as genetic susceptibility, mechanical loading, and trauma, may play more crucial roles in the pathogenesis of discrete endplate lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Another recent study by Farshad‐Amacker et al was able to demonstrate that endplate defects occupying ≥50% of the endplate area were more likely a risk factor for disc degeneration and Modic changes, but all these attempts were merely a qualitative grading rather than precise measurements. A recent quantitative measurement of the cadaveric endplate defect dimensions with micro CT revealed that larger and multiple defects were significantly associated with decreased intradiscal pressure and increased severity of disc degeneration . However, how this morphological variability of the endplate defect dimensions affects other spinal phenotypes, such as high‐intensity zones (HIZ), disc displacement and facet joint changes is still unknown.…”

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confidence: 99%

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Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Zehra

Cheung

Bow

et al. 2019

Journal Orthopaedic Research

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The aim of the current study was to investigate the multi-dimensional characteristics of lumbar endplate defects in humans in relation to disc degeneration and other MRI phenotypes as well as their role with pain and disability. A total of 108 subjects were recruited and underwent 3T MRI of the lumbar spine. Structural endplate defects were identified and their dimensions were measured in terms of maximum width and depth, and were then standardized to the actual width of the endplate and depth of the vertebral body, respectively. Both width and depth of all endplate defects in each subject were added separately and scores were assigned on the basis of size from 1 to 3. Combining both scores provided "cumulative endplate defect scores." Disc degeneration scores, Modic changes, disc displacement, HIZ, and facet joint changes were assessed. Subject demographics, pain profile, and Oswestry Disability Index (ODI) were also obtained. Endplate defects were observed in 67.5% of the subjects and in 13.5% of the endplates. All dimensions of endplate defects showed significance with disc degenerative scores, Modic changes, and posterior disc displacement (p < 0.05). Maximum width (p ¼ 0.009) and its standardized value (p ¼ 0.02), and cumulative endplate defect scores (p ¼ 0.004) increased with narrow facet joints. Cumulative endplate defect scores showed a strong positive association with ODI (p < 0.05) compared to disc degenerative scores. Large size endplate defects were strongly associated with degenerative spine changes and more back-related disability. Findings from this study stress the need to assess endplate findings from a multi-dimensional perspective, whose role may have clinical utility. ß 2019 Orthopaedic Research

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Zehra

Cheung

Bow

et al. 2019

Journal Orthopaedic Research

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“…These findings are in line with previous studies investigating the structural changes in subchondral bone associated with disc degeneration and describing the presence of significant fissures in subchondral bones close to degenerated discs; in particular, a recent study revealed the presence of increased porosity in great detail using µCT [39]. Another mechanical, histological, and micro-CT study of cadaver spines from Zehra et al [40] confirmed a stronger association between disc degeneration and large or multiple endplate defects.…”

Section: Discussionsupporting

confidence: 90%

Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain

et al. 2019

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Purpose To evaluate the relationship between degenerative disc, endplate Modic changes (MC) type I, and pain during upright weight-bearing MRI scan of the lumbar spine in a cohort of patients with non-specific low back pain. Materials and methodsWe evaluated 38 patients with non-specific low back pain and MRI evidence of Modic I vertebral changes. The patients were evaluated in a standard and upright weight-bearing position using a dedicated MR unit. The extent of endplate MC type I, intervertebral disc height at the involved level, and degree of degeneration in the same intervertebral disc were compared. Pain was assessed through the VAS questionnaire. Results In the upright position, the area of Modic I changes increased in 26 patients (68.4%, p ≤ 0.001) compared to the supine position. In the upright position, reduction in the disc height was found in 35 patients (92.1%). Correlation analysis showed moderate negative correlation (ρ = − 0.45) between intervertebral disc height and increase in the area of Modic I changes, and weak positive correlation (ρ = 0.12) between Pfirrmann grade and increase in the area of Modic I changes. At clinical evaluation, 30 patients (78.9%) reported worsening of low back pain standing in the upright position. Increase in VAS values on the upright position correlated significantly (ρ = 0.34) with an increase in the area of Modic I changes. Conclusions Our results showed the modifications of Modic I changes under loading, with MRI evidence of increased MC area extent in the upright position and correlation between Modic changes extension increase and increase in pain in the standing position. Weight-bearing MRI scans represent a valuable complement to standard sequences since they provide the radiologist with additional diagnostic information about low back pain. Graphical abstractThese slides can be retrieved from Electronic Supplementary Material. Key pointsSplendiani A, Bruno F, Marsecano C, Arrigoni F, di Cesare E, Barile A, Masciocchi C (2019) Modic I changes size increase from supine to standing MRI correlates with increase of pain intensity in standing position: uncovering the "biomechanical stress" and "active discopathy" theories in low back pain. Eur Spine J;

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Structural vertebral endplate nomenclature and etiology: a study by the ISSLS Spinal Phenotype Focus Group

et al. 2017

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Defects of the vertebral end plate: implications for disc degeneration depend on size

Cited by 33 publications

References 61 publications

Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: uncovering the “biomechanical stress” and “active discopathy” theories in low back pain

Structural vertebral endplate nomenclature and etiology: a study by the ISSLS Spinal Phenotype Focus Group

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