Herniation of Cartilaginous Endplates in the Lumbar Spine: MRI Findings

Joe, Eugene; Lee, Joon Woo; Park, Kun Woo; Yeom, Jin Sup; Lee, Eugene; Lee, Guen Young; Kang, Heung Sik

doi:10.2214/ajr.14.13319

Cited by 42 publications

(24 citation statements)

References 39 publications

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“…In this region, the CEP is thickest, likely due to annulus fibers passing through the CEP and anchoring to the adjacent bone which are not present in the center of the CEP . This may be a mechanically important junction in the disc as it experiences high tensile strains and consequently, is frequently the sight of CEP and annulus fibrosus herniation . CEP thickness at this junction decreases with age which may make the CEP more susceptible to failure.…”

Section: Discussionmentioning

confidence: 99%

“…14,33 This may be a mechanically important junction in the disc as it experiences high tensile strains [34][35][36] and consequently, is frequently the sight of CEP and annulus fibrosus herniation. 27,[37][38][39] CEP thickness at this junction decreases with age which may make the CEP more susceptible to failure. CEP axial area, which is enclosed by this outer boundary, also decreases with age ( Fig.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

MRI quantification of human spine cartilage endplate geometry: Comparison with age, degeneration, level, and disc geometry

DeLucca

Peloquin

Smith

et al. 2016

Journal Orthopaedic Research

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Geometry is an important indicator of disc mechanical function and degeneration. While the geometry and associated degenerative changes in the nucleus pulposus and the annulus fibrosus are well-defined, the geometry of the cartilage endplate (CEP) and its relationship to disc degeneration are unknown. The objectives of this study were to quantify CEP geometry in three dimensions using an MRI FLASH imaging sequence and evaluate relationships between CEP geometry and age, degeneration, spinal level, and overall disc geometry. To do so, we assessed the MRI-based measurements for accuracy and repeatability. Next, we measured CEP geometry across a larger sample set and correlated CEP geometric parameters to age, disc degeneration, level, and disc geometry. The MRI-based measures resulted in thicknesses (0.3–1 mm) that are comparable to prior measurements of CEP thickness. CEP thickness was greatest at the anterior/posterior (A/P) margins and smallest in the center. The CEP A/P thickness, axial area, and lateral width decreased with age but were not related to disc degeneration. Age-related, but not degeneration-related, changes in geometry suggest that the CEP may not follow the progression of disc degeneration. Ultimately, if the CEP undergoes significant geometric changes with aging and if these can be related to low back pain, a clinically feasible translation of the FLASH MRI-based measurement of CEP geometry presented in this study may prove a useful diagnostic tool.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

MRI quantification of human spine cartilage endplate geometry: Comparison with age, degeneration, level, and disc geometry

DeLucca

Peloquin

Smith

et al. 2016

Journal Orthopaedic Research

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“…Other studies have argued that any potential positive correlation between cartilage endplate herniations and pain and clinical symptoms will be confounded by the inflammatory effect of the nucleus material in the extrusion (Joe et al. ).…”

Section: Discussionmentioning

confidence: 99%

“…Conversely, where there is pure nucleus migration to the periphery of the disc without any attached endplate cartilage there may be a relatively rapid resolution of both the inflammatory process and pain symptoms (Autio et al 2006;Lama et al 2013;Shan et al 2014). Other studies have argued that any potential positive correlation between cartilage endplate herniations and pain and clinical symptoms will be confounded by the inflammatory effect of the nucleus material in the extrusion (Joe et al 2015).…”

Section: Comparison With Human Discsmentioning

confidence: 99%

How maturity influences annulus‐endplate integration in the ovine intervertebral disc: a micro‐ and ultra‐structural study

2016

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The annulus-endplate anchorage system plays a vital role in structurally linking the compliant disc to its adjacent much more rigid vertebrae. Past literature has identified the endplate as a region of weakness, not just in the mature spine but also in the immature spine. The aim of this structural study was to investigate in detail the morphological changes associated with annulus-endplate integration through different stages of maturity. Ovine lumbar motion segments were collected from two immature age groups: (i) newborn and (ii) spring lamb (roughly 3 months old); these were compared with a third group of previously analysed mature ewe samples (3-5 years). Sections from the posterior region of each motion segment were obtained for microstructural analysis and imaged in their fully hydrated state via differential interference contrast (DIC) optical microscopy. Selected slices were further prepared and imaged via scanning electron microscopy (SEM) to analyse fibril-level modes of integration. Despite significant changes in endplate morphology, the annular fibre bundles in all three age groups displayed a similar branching mechanism, with the main bundle splitting into several sub-bundles on entering the cartilaginous endplate. This morphology, previously described in the mature ovine disc, is thought to strengthen significantly annulus-endplate integration. Its prevalence from an age as young as birth emphasizes the critical role that it plays in the anchorage system. The structure of the branched sub-bundles and their integration with the surrounding matrix were found to vary with age due to changes in the cartilaginous and vertebral components of the endplate. Microscopically, the sub-bundles in both immature age groups appeared to fade into the surrounding tissue due to their fibril-level integration with the cartilaginous endplate tissue, this mechanism being particularly complex in the spring lamb disc. However, in the fully mature disc, the sub-bundles remained as separate entities throughout the full depth of their anchorage into the cartilaginous endplate. Cell morphology was also found to vary with maturity within the cartilaginous matrix and it is proposed that this relates to endplate development and ossification.

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“…These changes are associated with vertebral endplate fissures and disc herniation. [11][12][13] . However, little is known about the relationship between MCs and rLDH.…”

Section: Introductionmentioning

confidence: 99%

Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present

Lü

Liu

et al. 2020

Preprint

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Objective: To investigate the relationship between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH), and that between the herniated disc component and rLDH following percutaneous endoscopic lumbar discectomy (PELD). Methods: We included 102 (65 males, 37 females, aged 20–66 yrs) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperatively. The presence and type of Modic changes were assessed. During surgery the herniated disc component of each patient was classified into two groups: nucleus pulposus group, hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of rLDH was assessed based on more than 2-year follow-up. Results: In total, 11 patients were lost to follow up; the other 91 were followed up during 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P<0.05). We found 2 cases of rLDH in the non-MC group (n=71); 6 cases rLDH were found in the MC group (n=28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P>0.05). rLDH was more common in patients with MCs (P<0.05). We found 5 rLDH cases in the hyaline cartilage group (n=32); 3 rLDH cases were found in the nucleus pulposus group (n=67). rLDH was more common in the hyaline cartilage group (P<0.05). Conclusions: rLDH following PELD preferentially occurs when MCs or herniated cartilage are present.

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Herniation of Cartilaginous Endplates in the Lumbar Spine: MRI Findings

Cited by 42 publications

References 39 publications

MRI quantification of human spine cartilage endplate geometry: Comparison with age, degeneration, level, and disc geometry

MRI quantification of human spine cartilage endplate geometry: Comparison with age, degeneration, level, and disc geometry

How maturity influences annulus‐endplate integration in the ovine intervertebral disc: a micro‐ and ultra‐structural study

Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present

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