Vertebral Endplate Defect as Initiating Factor in Intervertebral Disc Degeneration

Rade, Marinko; Määttä, Juhani; Freidin, Maxim B.; Airaksinen, Olavi; Karppinen, Jaro; Williams, Frances

doi:10.1097/brs.0000000000002352

Cited by 85 publications

(79 citation statements)

References 32 publications

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“…Earlier studies have shown, that endplate changes and DDD are related. [20,8] In the present study, no relevant increase of DDD grade was seen during follow up.…”

Section: Discussioncontrasting

confidence: 57%

Incidence and clinical impact of vertebral endplate changes after limited lumbar microdiscectomy and implantation of a bone-anchored annular closure device

Kienzler

Rey

Wetzel

et al. 2020

Preprint

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Background: An annular closure device (ACD) could potentially prevent recurrent herniation by blocking larger annular defects after limited microdiscectomy (LMD). The purpose of this study was to analyze the incidence of endplate changes (EPC) and outcome after LMD with additional implantation of an ACD to prevent reherniation. Methods: This analysis includes data from a) RCT study-arm of patients undergoing LMD with ACD implantation and b) additional patients undergoing ACD implantation at our institution. Clinical findings (VAS,ODI), radiological outcome (reherniation, implant integrity, volume of (EPC) and risk factors for EPC were assessed. Results: Seventy-two patients (37men, 47±11.63yo) underwent LMD and ACD implantation between 2013-2016. A total of 71 (99%) patients presented with some degree of EPC during the follow-up period (14.67±4.77months). In the multivariate regression analysis, localization of the anchor was the only significant predictor of EPC (p=0.038). The largest EPC measured 4.2 cm3. Reherniation was documented in 17 (24%) patients (symptomatic: n=10; asymptomatic: n=7). Six (8.3%) patients with symptomatic reherniation underwent rediscectomy. Implant failure was documented in 19 (26.4%) patients including anchor head breakage (n=1, 1.3%), dislocation of the whole device (n=5, 6.9%), and mesh dislocation into the spinal canal (n=13, 18%). Mesh subsidence within the EPC was documented in 15 (20.8%) patients. Seven (9.7%) patients underwent explantation of the entire, or parts of the device.Conclusion: Clinical improvement after LMD and ACD implantation was proven in our study. High incidence and volume of EPC did not correlate with clinical outcome. Mechanical friction of the polymer mesh with the endplate is most likely the cause of EPC after ACD.

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“…Earlier studies have shown, that endplate changes and DDD are related. [20,8] In the present study, no relevant increase of DDD grade was seen during follow up.…”

Section: Discussioncontrasting

confidence: 57%

Incidence and clinical impact of vertebral endplate changes after limited lumbar microdiscectomy and implantation of a bone-anchored annular closure device

Kienzler

Rey

Wetzel

et al. 2020

Preprint

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“…We can appreciate the reduction in L5-S1 intervertebral disc hydration and the increased extent of Modic 1 changes at the level of both endplates at the same level [20]. The vertebral body endplates are indeed considered the most vulnerable structure functional spinal unit [21]. They have a bony component and a hyaline cartilaginous component.…”

Section: Discussionmentioning

confidence: 97%

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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“…Rostral and caudal endplates were coded using middle sagittal slices at each lumbar segment for all baseline, and follow-up MRI scans, with no prior clinical knowledge of clinical status, scan sequence or subject details. Rostral and caudal endplate scores were summed to generate a total endplate (TEP) score for each lumbar level (13). Inter-rater agreement for the coding of endplate defect was calculated…”

Section: Evaluation Of Endplate Defectmentioning

confidence: 99%

“…Vertebral endplate defect heritability 8 LDD had been scored using 4-point grading system. In the 4-point grading system disc signal, disc bulge, disc height loss and anterior osteophytes were coded 0-3 from the atlas, using the middle slice MR image, as described previously (2,13,14). Disc degeneration summary score was calculated by summing scores for the four traits at each of the five lumbar levels.…”

Section: Evaluation Of Disc Degenerationmentioning

confidence: 99%

Endplate Defect Is Heritable, Associated With Low Back Pain and Triggers Intervertebral Disc Degeneration

Munir

Freidin

Rade

et al. 2018

Spine

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Vertebral Endplate Defect as Initiating Factor in Intervertebral Disc Degeneration

Abstract: 2.

Cited by 85 publications

References 32 publications

Incidence and clinical impact of vertebral endplate changes after limited lumbar microdiscectomy and implantation of a bone-anchored annular closure device

Incidence and clinical impact of vertebral endplate changes after limited lumbar microdiscectomy and implantation of a bone-anchored annular closure device

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

Endplate Defect Is Heritable, Associated With Low Back Pain and Triggers Intervertebral Disc Degeneration

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