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Lumbar endplate lesions associated with disc degeneration and low back pain
The award-winning research revealed a clear dosage effect between lumbar vertebral endplate lesions and disc degeneration.
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AMSTERDAM — Endplate lesions are associated with back pain history, according to data presented at SpineWeek 2012, here.
“We confirmed that, overall, the presence of endplate lesions was associated with frequent back pain. Particularly, large endplate lesions were associated with both occasional and frequent back pain,” Yue Wang, MD, PhD, of Hangzhou, China, said. “These associations remained after we further adjusted for the effects of disc degeneration (DD) in the statistical model, while moderate and severe DD was also associated with back pain.”
Wang and co-investigators at the University of Alberta, Canada — Tapio Videman, MD, PhD, and Michele C. Battié, PhD — were awarded the International Society for the Study of the Lumbar Spine (ISSLS) 2012 Clinical Prize for the study.
Discography to grade degeneration
The researchers analyzed data from a spine archive for 1,148 lumbar vertebral endplate and 443 intervertebral discs from 109 men with a mean age 52 years. Occupational, health history information, and low back pain data were available for 69 patients.
Another component of the analysis involved grading DD severity using discography. Vertebral endplates were visually inspected to examine the presence or absence of lesions. Endplate lesions were classified into four types, including fractures, Schmorl’s nodes, calcifications and erosions, which were ranked by size based on the involved endplate area as none, small, mid-size or large lesions, and their quantity was noted.
“Large means more than half of the endplate was involved,” Wang said.
Schmorl’s nodes, shown here, were included in the definition of endplate lesions. Under visual inspection on discography, these and other lesions were measured and ranked by size to estimate their severity.
Images: Wang Y
As an intervertebral disc has two adjacent vertebral endplates, the number of lesions per endplate was also determined.
Numeric ranking
Wang and colleagues then applied numeric values to these measurements, and examined the associations between the subjects’ back pain history and endplate lesions and DD. The team observed a clear dosage effect between the endplate lesions and DD, Wang said.
“The associations that we observed are remarkable,” he said. “Overall, the presence of endplate lesions was associated with disc degeneration, with large lesions associated with more severe disc degeneration.”
Endplate erosion is another type of endplate lesion that researchers classified. The team studied 1,148 lumbar vertebral endplates from a large lumbar spine archive of middle-aged men (mean age 52 years).
The more lesions that were present adjacent to the endplate, the more severe was the DD observed, Wang said. He also noted that erosion lesions were more strongly associated with DD than Schmorl’s nodes
“Lumbar endplate lesions may be an important key to better understanding both disc degeneration and back pain,” the investigators wrote in the abstract.
Wang said one of the study limitations is that the subjects were all middle-aged men. – by Susan M. Rapp
References:
Wang Y, Videman T, Battié MC. ISSLS Prize Winner: Lumbar vertebral endplate lesions: Associations with disc degeneration and back pain history. Spine. 2012;37(17):1490-1496.
Wang Y, Videman T, Battié MC. Lumbar vertebral endplate lesions: Associations with disc degeneration and back pain history. Paper #241. Presented at SpineWeek 2012. May 28-June 1. Amsterdam.
For more information:
Yue Wang, MD, PhD, can be reached at Department of Orthopedic Surgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, PR, China; email: wangyuespine@gmail.com.
Disclosure: Wang has no relevant financial disclosures.
Perspective
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Gunnar B.J. Andersson, MD, PhD
For years researchers in the back pain area have focused on the intervertebral disc. Limited interest has been given to the endplate, which is a cartilage structure that separates the disc from the vertebral body. We acknowledge endplate changes such as Schmorl’s nodes, calcifications and fractures, which can all be seen on MRI scans, but have not been able to directly relate them to the presence of back pain. This study is unique in that not only did the investigators have access to radiographic and histological spine specimens, but in addition they had information about previous back pain, back injuries and occupational history, as well discography data.
While the study does not provide conclusive data about the importance of any of the observed lesions to development of back pain or to disc degeneration, it raises the possibility and should provide an incentive for further research into the importance of the endplate.
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