Tidemark Avulsions are a Predominant Form of Endplate Irregularity

Berg-Johansen, Britta; Jain, Deeptee; Liebenberg, Ellen; Fields, Aaron J.; Link, Thomas M.; O’Neill, Conor; Lotz, Jeffrey C.

doi:10.1097/brs.0000000000002545

Cited by 16 publications

(19 citation statements)

References 31 publications

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“…Previous work has focused mainly on the bony vertebral endplates, in cadaveric or animal tissues, and on MRI (Adams and Dolan, 2012; Adams et al, 2000; Berg‐Johansen et al, 2018b; Berg‐Johansen et al, 2018a; Feng et al, 2018; Fields et al, 2014; Rade et al, 2018; Wang et al, 2012). Some defects in cadaveric tissues may be artefactual, and defects in young animal tissues may not accurately represent those in ex vivo tissues obtained from living humans, as identified in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…The endplate may be most relevant clinically, considering that endplate defects are associated with pathologic disc innervation (Fields et al, 2014), and a history of severe back pain (Lama et al, 2018). Cadaver and histology studies show that tidemark avulsions, CEP ruptures, and bony endplate lesions are the predominant form of endplate irregularity (Berg‐Johansen et al, 2018b; Berg‐Johansen et al, 2018a; Fields et al, 2014; Kakitsubata et al, 2002; Tanaka et al, 1993; Wang et al, 2012), and that fragmentation of the CEP is associated with back pain and sciatica (Lama et al, 2014). However, the structural features of damaged CEPs have not been well characterized, and this hinders our understanding of the etiology of disc degeneration and pain.…”

Section: Introductionmentioning

confidence: 99%

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Damage to the human lumbar cartilage endplate and its clinical implications

et al. 2020

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The cartilaginous endplate (CEP) is a thin layer of hyaline cartilage, and plays an important role in the diffusion of nutrients into the intervertebral discs. Its damage may seriously affect the disc degeneration, and result in low back pain (LBP). However, the structural features of damaged CEPs have not been well characterized, and this hinders our understanding of the etiology of disc degeneration and pain. To present the How to cite this article: Huang B, Liu J, Wei X, et al. Damage to the human lumbar cartilage endplate and its clinical implications.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Damage to the human lumbar cartilage endplate and its clinical implications

et al. 2020

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“…Another informative correlation determined from the present study was between the micromechanical AFM measurements ( E ind CEP, AF, AF‐EP) and whole motion segment macro‐mechanical properties (toe and linear modulus). Other groups have previously evaluated NP (Iatridis et al, 1996), AF (Iatridis et al, 1999), endplate (Berg‐johansen et al, 2018), and motion segment (Cortes et al, 2014; Pollintine et al, 2010) mechanics in isolated studies. To the best of our knowledge, this is the first study to report a relationship between micro and macroscale mechanic perturbations in IVD tissues with degeneration.…”

Section: Discussionmentioning

confidence: 99%

Degeneration alters structure‐function relationships at multiple length‐scales and across interfaces in human intervertebral discs

et al. 2020

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Intervertebral disc (IVD) degeneration and associated back pain place a significant burden on the population. IVD degeneration is a progressive cascade of cellular, compositional, and structural changes, which results in a loss of disc height, disorganization of extracellular matrix architecture, tears in the annulus fibrosus which may involve herniation of the nucleus pulposus, and remodeling of the bony and cartilaginous endplates (CEP). These changes to the IVD often occur concomitantly, across the entire motion segment from the disc subcomponents to the CEP and vertebral bone, making it difficult to determine the causal initiating factor of degeneration. Furthermore, assessments of the subcomponents of the IVD have been largely qualitative, with most studies focusing on a single attribute, rather than multiple adjacent IVD substructures. The objective of this study was to perform a multiscale and multimodal analysis of human lumbar motion segments across various length scales and degrees of degeneration. We performed multiple assays on every sample and identified several correlations between structural and functional measurements of disc subcomponents. Our results demonstrate that with increasing Pfirrmann grade there is a reduction in disc height and nucleus pulposus T2 relaxation time, in addition to alterations in motion segment macromechanical function, disc matrix composition and cellular morphology. At the cartilage endplate‐vertebral bone interface, substantial remodeling was observed coinciding with alterations in micromechanical properties. Finally, we report significant relationships between vertebral bone and nucleus pulposus metrics, as well as between micromechanical properties of the endplate and whole motion segment biomechanical parameters, indicating the importance of studying IVD degeneration as a whole organ.

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“…Forms of damage have been described as fractures (Fig. 1E), erosions, Schmorl’s nodes, avulsions, calcification, and rim degeneration [33, 82, 83]. Depending on the imaging technique, the prevalence varies between nodes and erosions being most prevalent (22% and 14%) (Fig.…”

Section: Endplate Pathology and Relations To Disc Degenerationmentioning

confidence: 99%

“…1C) to avulsions and rim degeneration (35% and 50%). In a recent histopathology study, Berg-Johansen et al reported that ninety percent of avulsions were subclassified as “tidemark avulsions,” a form of endplate irregularity wherein the outer annulus separates from the vertebra at the enthesis tidemark [83] (Fig. 1B).…”

Section: Endplate Pathology and Relations To Disc Degenerationmentioning

confidence: 99%

Contribution of the Endplates to Disc Degeneration

et al. 2018

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Purpose of review: The endplates form the interface between the rigid vertebral bodies and compliant intervertebral discs. Proper endplate function involves a balance between conflicting biomechanical and nutritional demands. This review summarizes recent data that highlight the importance of proper endplate function and the relationships between endplate dysfunction, adjacent disc degeneration, and axial low back pain. Recent findings: Changes to endplate morphology and composition that impair its permeability associate with disc degeneration. Endplate damage also associates with disc degeneration, and the progression of degeneration may be accelerated and the chronicity of symptoms heightened when damage coincides with evidence of adjacent bone marrow lesions. Summary: The endplate plays a key role in the development of disc degeneration and low back pain. Clarification of the mechanisms governing endplate degeneration and developments in clinical imaging that enable precise evaluation of endplate function and dysfunction will distinguish the correlative vs. causative nature of endplate damage and motivate new treatments that target pathologic endplate function.

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Tidemark Avulsions are a Predominant Form of Endplate Irregularity

Abstract: 3.

Cited by 16 publications

References 31 publications

Damage to the human lumbar cartilage endplate and its clinical implications

Damage to the human lumbar cartilage endplate and its clinical implications

Degeneration alters structure‐function relationships at multiple length‐scales and across interfaces in human intervertebral discs

Contribution of the Endplates to Disc Degeneration

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