The Role of the Vertebral End Plate in Low Back Pain

Lotz, Jeffrey C.; Fields, Aaron J.; Liebenberg, Ellen

doi:10.1055/s-0033-1347298

Cited by 204 publications

(230 citation statements)

References 144 publications

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“…loss of disc hydration and height loss, osteophytes) that can affect biomechanics and can potentially lead to nerve root/spinal cord compression, and negatively affect spinal stability and function, which may necessitate treatment. 45 Biological therapeutics (e.g. stem cells, growth factors) have been developed to help regenerate or halt degeneration of a disc.…”

Section: Discussionmentioning

confidence: 99%

The UTE Disc Sign on MRI

Pang

Bow

Cheung

et al. 2018

Spine

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Study Design Cross-sectional. Objective To assess the distribution of the ultra-short time-to-echo (UTE) Disc Sign (UDS) and its association with disc degeneration, other MRI phenotypes, pain and disability profiles. Summary of Background Data Disc degeneration has been conventionally assessed by T2-weighted (T2W) signal intensity on MRI; however, its clinical utility has been questionable. UTE MRI assesses short T2 components. The authors have identified a new imaging biomarker on UTE – the UDS. Methods 108 subjects were recruited. T2W MRI assessed disc degeneration and other phenotypes, and T1-rho MRI values represented quantitative proteoglycan disc profiles of L1-S1. UDS was detected on UTE (i.e. hyper-/hypo-intense disc band). A UDS score (cumulative number of UDS levels) and T2W summated lumbar degenerated scores (cumulative disc degeneration score) were assessed. Subject demographics, chronic low back pain (LBP) and disability profiles (Oswestry Disability Index: ODI) were obtained. Results UDS was noted in 39.8% subjects, 61.4% occurred at the lower lumbar spine and 39.5% had multi-level UDS. UDS subjects had significantly greater severity and extent of disc degeneration, and Modic changes (p<0.05). By disc levels, a higher prevalence of disc degeneration/displacememt, Modic changes and spondylolisthesis were noted in UDS discs than non-UDS discs (p<0.05). T1-rho values were also lower in UDS discs (p=0.022). The majority of UDS could not be detected on T2W. The UDS score significantly correlated with worse ODI scores (r=0.311; p=0.001), whereas T2W cumulative disc degeneration score did not (r=0.13; p=0.19). LBP subjects exhibited more multi-level UDS (p<0.015) but not on T2W MRI (p=0.53). The UDS score was significantly related to LBP (p=0.009), whereas T2W cumulative disc degeneration score was not (p=0.127). Conclusions This is the first study to report “UDS” in humans. UDS is a novel imaging biomarker that is highly associated with degenerative spine changes, chronic LBP and disability than conventional T2W MRI.

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Section: Discussionmentioning

confidence: 99%

The UTE Disc Sign on MRI

Pang

Bow

Cheung

et al. 2018

Spine

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“…Type III changes are represented by decreased signal intensity on both T1-and T2-weigthed images that correlate with dense woven bone (sclerosis) (Figure 1). It has been suggested that moderate to severe Modic Type I or II end plate abnormalities correlate 100% of the time with positive concordant pain at the adjacent disc [52]. Evidence suggest that innervated end plate damage can be a source of chronic low back pain, its role in patients is likely underappreciated because innervated damage is poorly visualized with diagnostic imaging [53].…”

Section: /10mentioning

confidence: 99%

Etiology and Risk Factors of Lumbar Intervertebral Disc (IVD) Degeneration

Debnath¹

2018

RMES

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Biological factors (Table 1) Changes in ECM (Extracellular Matrix): Collagen synthesis increases in the initial stages of degeneration with a clear increase in type II Collagen in the NP (maybe indicating repair mechanism) [9]. As the degeneration progresses the synthesis pattern changes and more type II Collagen is synthesized in AF. Type I collagen is synthesized in the deep region of AF and NP. Type X collagen formation is associated with chondrocyte agglomerates and tears of degenerated IVDs. The synthesis of proteoglycans also changes with decline in production of aggrecan and increase in the synthesis of versican, biglycan and decorin. There is reduced Glycosaminoglycans (GAGs) esp. modification of chondroitin sulfate to keratan sulfate. These results in disc desiccation and degeneration [10]. The remodeling of the ECM results from these changes occurring simultaneously. The protagonists of the process are the matrix metallo-proteinases (MMPs) [11]. There are ADAMTS (a desintegrin and metalloproteinase with thrombospondin), which play similar but more powerful roles like MMPs. Both these families have the same endogenous inhibitors called TIMPs (Tissue inhibitor matrix metallo-proteinases), which act synergistically in the remodeling of ECM [12]. Review Article Research in Medical & Engineering Sciences C CRIMSON PUBLISHERS Wings to the Research 1/10Copyright © All rights are reserved by Ujjwal K Debnath. Volume 4 -Issue 5 ISSN: 2576-8816 AbstractLumbar degenerative disc disease (DDD) is a progressive condition that exists along a continuum of pathologic processes. The disease starts as desiccation of the nucleus pulposus, to annular tearing, diffuse disc bulging, and disc space collapse, the degenerative process can occur over the course of decades, culminating in substantial debilitation. Clinically DDD presents with back pain and/or radiculopathy, can limit work and productivity. Additionally, the cost of treating this condition is especially high, and billions of dollars are spent on managing degenerative spinal processes annually.In this review, the main focus is on the recent advances in studies on the most extensively examined risk factors and genetic factors associated with DDD in humans. A number of genetic defects have been correlated with structural and functional changes within the intervertebral disc (IVD), which may compromise the disc's mechanical properties and metabolic activities. These studies have begun to shed light on the molecular basis of DDD, suggesting that genetic factors are important contributors to the onset and progression of IDD. By continuing to improve our understanding of the molecular mechanisms of DDD, specific early diagnosis and more effective treatments for this disabling disease may be possible in the future. Res Med Eng Sci 2/10How Proinflammatory cytokinesMost important cytokines which influences the IVD degeneration process are Interleukin -1 (IL-1) and Tumor necrosis factor-α (TNF-α). Large volumes of research and evidence suggest these cytokines are directly ...

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“…The prevalence increases with age. Thus, the phenomenon is quite rare at the age of 20 years, but up to 20% have MC at age 60 and it occurs most frequently in the lumbar region and especially in the L4/L5 and L5/S1 segments, presumably arising secondarily to significant mechanical forces present in the lower lumbar spine [5]. MC are normally seen at the same vertebral level as disc degeneration.…”

Section: Prevalencementioning

confidence: 99%

“…Additional observations point to a possible association between the high proportion of hyaline cartilage in the herniated disc mass and the development of MC in the adjacent segments [15]. As the bony endplates normally have a rich supply of small free nerve endings, degenerative developments and inflammation can trigger a localized inflammatory pain pattern [5,16]. Typically, the pain is exacerbated by physical stress or exercise, and it is often worse at night.…”

Section: Etiology and Painmentioning

confidence: 99%

Vertebral endplate (modic) changes and the treatment of back pain using antibiotics

Manniche¹

2014

Clinical Practice

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Practice points• Vertebral endplate changes/modic changes (MC) are the MRI-images of inflammatory vertebral endplate damage that are often related to general disc degeneration. • In patients with prolonged back pain, the prevalence of MC is 40%.• In individuals with MC, more than 90% will have back pain within 1 year.• MC often causes localized pain 24/7. • Nocturnal pain is the rule rather than the exception.• New MC type 1 occurs frequently during the course of a disc herniation.• There are currently no better diagnostic methods in MC than MRI and a case story of the typical inflammatory back pain pattern and the likely presence of a disc herniation within the recent few years. • In biopsies from prolapsed disc mass, bacteria -most commonly Propionibacterium acnes of the oral cavity class -are found in at least 40% of patients. • In a MC subgroup with persistent back pain after a disc herniation and emerging MC type 1, it is relevant to consider: 'disc infection'. • In one high quality RCT, including a subgroup of post-prolapse/MC patients with chronic pain, demonstrated clinically significant improvements in more than 50% of the patients after 3 months of treatment with a broad spectrum antibiotic. • MC type 1 are generally considered to be an important prognostic marker of a poor prognosis.Vertebral end-plate changes/modic changes are the MRI-image of inflammatory vertebral endplate damage, most often related to general disc degeneration. However, in a subgroup of patients disc infection may be the causal factor. In patients with prolonged back pain, the prevalence of modic changes (MC) is 40%. In most cases, nocturnal pain is the rule and MC causes highly localized pain 24/7. There are currently no better diagnostic methods than MRI and case history findings. In persistent back pain after a disc herniation and emerging MC type 1, it is relevant to consider: 'disc infection'. Most commonly, Propionibacterium acnes is involved. Long-term antibiotics may be effective. Keywords: antibiotics • back pain • chronic pain • disc prolapse • discitis • modic changes • vertebral endplateModic et al. [1] defined three types of vertebral endplate (modic) changes as visualized on MRI in 1988 and in 2001, Stirling [2] cultured bacteria in disc biopsies from more than 50% of patients investigated who had undergone surgery for a prolapsed disc. By combining these findings researchers from The Spine Center of Southern Denmark established a hypothesis in 2008 regarding MC including its prevalence, etiology,

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The Role of the Vertebral End Plate in Low Back Pain

Cited by 204 publications

References 144 publications

The UTE Disc Sign on MRI

The UTE Disc Sign on MRI

Etiology and Risk Factors of Lumbar Intervertebral Disc (IVD) Degeneration

Vertebral endplate (modic) changes and the treatment of back pain using antibiotics

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