Painful Lumbar End-Plate Disruptions: A Significant Discographic Finding

Hsu, Ken Y.; Zucherman, James; Derby, Richard; White, Arthur H.; Goldthwaite, Noel; Wynne, Gar

doi:10.1097/00007632-198801000-00018

Cited by 30 publications

(8 citation statements)

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“…Abnormalities of the endplates and adjacent marrow may stimulate elements of the sympathetic nervous system [1,2,14]. Clinically, direct endplate manipulation and discographic loading of disrupted endplates has been associated with concordant pain symptoms [6,13,18,29]. In the present study, all patients with MRI vertebraI body changes and evidence of endplate disruptions who also had discography had concordant pain at the corresponding level.…”

Section: Discussionmentioning

confidence: 56%

“…Yet, some patients have severe discographically concordant pain and normal disc m o r p h o l o g y [24,27]. For a subgroup of patients, the pain at discography has been related to fissures and erosions of the endplates [6,13]. Altered signals have also been found adjacent to the endplates of vertebral bodies of degenerative spines, indicating changes in the relative amounts of lipid or hydration [7].…”

Section: Introductionmentioning

confidence: 99%

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Vertebral body MRI related to lumbar fusion results

et al. 1997

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The evaluation of continued pain after a technically successful posterolateral lumbar spine fusion is often challenging. Although the intervertebral disc is often a source of low back pain, abnormal endplates may also be a focus of pain, and possibly a source of continued pain after a posterolateral fusion. MRI allows noninvasive evaluation for disc degeneration, as well as for abnormal endplates and adjacent vertebral body marrow. Previous studies have found inflammatory marrow changes, adjacent to abnormal endplates, associated with disc degeneration in low back pain patients. In this study, preoperative MRI scans in 89 posterolateral lumbar fusion patients were reviewed, by an independent radiologist, to determine whether vertebral body marrow changes adjacent to the endplates were related to contined pain. Independent chart review and follow-up telephone interview of all patients at a 4-year follow-up (mean) formed the basis for the clinical results. Vertebral body MRI signals consistent with inflammatory or fatty changes were found in 38% of patients, and always occurred adjacent to a degenerated disc. Inflammatory MRI vertebral body changes were significantly related to continued low back pain at P = 0.03. We conclude that posterolateral lumbar fusion has a less predictable result for the subset of degenerative disc patients with abnormal endplates and associated marrow inflammation. More research is needed to determine the biological and biomechanical effects of a posterolateral fusion upon the endplate within the fused segments. If indeed further study supports the hypothesis that abnormal endplates associated with inflammation are a source of pain, then treating the endplates directly by anterior fusion may be a preferred treatment for this subset of degenerative patients.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Vertebral body MRI related to lumbar fusion results

et al. 1997

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“…Reloading the damaged endplates increased the strains in both models; however, the increase in strain was nearly 40% less for the double-layer endplate. Although preliminary, these findings suggest that double-layer endplates are more structurally redundant, and in this manner they could mitigate the accumulation of endplate damage, which is thought to accelerate disc degeneration 2 and to associate with low back pain 41 .…”

Section: Discussionmentioning

confidence: 85%

Seeing Double

Fields

Sahli

Rodriguez

et al. 2012

Spine

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Study design Experimental and computational assessment of thickness, porosity, biomechanical behavior, and adjacent disc glycosaminoclycan (GAG) content in double-layer and single-layer bony endplate samples harvested from human cadaver spines. Objective Determine if the second layer of bone in double-layer vertebral endplates allows the superficial layer to achieve a more optimal balance between its biomechanical and nutritional functions. Summary of background data Proper disc health requires the endplate to balance opposing biomechanical and nutritional functions. Previous studies investigating endplate function report the occurrence of double-layer endplates, but it remains unclear whether the second layer of bone has any functional advantage. Such information could shed light on the factors that protect against disc degeneration. Methods Six lumbar spines were obtained from human cadavers (32–84 years) and scanned with magnetic resonance imaging. Cylindrical cores that included the endplate and underlying trabecular bone were harvested from the center of the superior vertebral endplates (six double-layer endplates and twelve single-layer endplates) and imaged using micro-CT. The thickness and porosity of the bony endplate layers was measured for each core. High-resolution finite element analysis was performed to assess biomechanical behavior. GAG content within the adjacent nucleus tissue was quantified using the dimethylmethylene blue technique. Results The superficial layer of the double-layer endplates was 50% thinner (p = 0.009) and tended also to be more porous than single-layer endplates. Strains were higher in thinner endplates; however, the second layer of bone in the double-layer endplates had a stiffening effect so that despite being thinner than single-layer endplates, the superficial layer of the double-layer endplates had a similar risk of damage. After adjusting for age, GAG content was significantly higher in the nucleus tissue adjacent to the double-layer endplates (p = 0.01). Conclusion Compared to single-layer endplates, double-layer endplates appear to permit a more optimal balance between endplate biomechanical and nutritional function and may therefore offer a significant protective factor against disc degeneration.

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“…Of the discs with radial tears in the current study, 63% bordered at least one defected endplate, and endplate defects were more frequently innervated — and to a greater degree — than were radial tears. Consistent with this view, Hsu et al report that the probability of reproducing patient symptoms during discography was significantly greater in cases with endplate damage [39]. Hence, the existence of highly innervated endplate pathologies along with annulus tears makes it difficult to discern the pain source.…”

Section: Discussionmentioning

confidence: 93%