Lumbar Disk Herniation: Correlation of Histologic Findings with Marrow Signal Intensity Changes in Vertebral Endplates at MR Imaging

Schmid, G.; Witteler, A.; Willburger, R. E.; Kühnen, C.; Jergas, M.; Koester, Odo

doi:10.1148/radiol.2312021708

Cited by 127 publications

(92 citation statements)

References 28 publications

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“…Elderly people (over 60 years old) were excluded because of the common, age-dependent, degenerative changes in intervertebral discs and bone marrow, which may hamper the assessment of the subchondral abnormalities. The number of patients in this study was limited because M1 as a single finding is not common among patients with chronic LBP even though it is in association with disc herniation [2,22]. In our study, the carefully selected group of LBP patients with M1 consisted of 24 (2.4%) patients of the 1,015 base population.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, the carefully selected group of LBP patients with M1 consisted of 24 (2.4%) patients of the 1,015 base population. In previous studies, the reported prevalence of subchondral signal abnormalities varies, that of hypointensities between 4% and 16% [2,6,11,13,17,22]. This is obviously due to varying criteria for abnormalities and selection of subjects.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that they may represent different consecutive phases of the degenerative process in the subchondral marrow [3,17]. The importance of the endplate [21,22] and subchondral bone [8] for the integrity of the intervertebral disc has been pointed out. An injury to the vertebral body endplate has been found to provide a potent mechanical stimulus for disc degeneration [20] and tissue trauma following fracture has been suggested to cause accelerated intervertebral disc degeneration [10].…”

Section: Discussionmentioning

confidence: 99%

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MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

et al. 2008

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Subchondral signal abnormalities have been suggested to play an important role in chronic low back pain (LBP) syndromes. Their natural course is not well known. In this study the morphology and natural course of isolated subchondral signal abnormalities in the lumbosacral spine were analyzed with MRI. Twenty-four chronic LBP patients with a subchondral hypointensity on T1-weighted image (hyperintense on T2), indicating edema, were selected from a base population of 1,015 consecutive LBP patients to a follow-up MRI study within 18-72 months. Exclusion criteria were age [60 years, nerve root compression, a more specific back disease or a recent or major spine operation. The size and location of each subchondral signal abnormality and endplate lesion and the degree of degenerative disc changes were evaluated and compared between the baseline and follow-up studies. Most subchondral hypointensities were found at the L4/L5 or L5/S1 disc space, anteriorly and in both adjacent endplates. Almost all (53/54) hypointensities were associated with an endplate lesion. Twelve of the 54 subchondral hypointensities enlarged, six remained constant and 36 decreased or disappeared while five new ones appeared. Twenty-two (41%) hypointensities changed totally to hyperintensities or to mixed lesions. If the hypointensity increased, decreased or changed into hyperintensity, a change tended to develop in the adjacent endplate. If the hypointensity was absent or unchanged, endplate lesions did not tend to progress. In the absence of disc herniation or other specific spinal disease, subchondral hypointensities indicating edema are uncommon. They seem to have a highly variable course. There appears to be a link between endplate lesions and subchondral signal abnormalities. Further study is needed to explain the contribution of these findings to low back symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

et al. 2008

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“…Modic-associated proinflammatory biochemical mediators have been suggested to be a major origin of pain [6]. MT1 converts to either MT2 or to a normal stage from 14 months to 3 years [20].…”

Section: Discussionmentioning

confidence: 99%

“…This is accompanied by increased vascular density, increased number of nerve endings and increased levels of proinflammatory biochemical mediators [5], which might be of pathogenic importance for the development of pain [6]. Generally, Modic type 2 (MT2) and type 3 changes are thought to represent the end stage of the degenerative process, and are not assumed to cause symptoms [7].…”

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confidence: 99%

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

et al. 2011

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Background There is evidence for an association between Modic type 1 and pain in patients with low back pain (LBP), but little knowledge about its effect on clinical outcomes. Purpose (1) To assess the prevalence of Modic changes, (2) to determine if Modic changes influence the clinical course of LBP, and (3) to identify prognostic factors for recovery. Study design/setting Prospective clinical cohort study, with a 1-year follow-up. The treatment consisted of brief intervention and instruction in stretching. Patient's sample Two hundred and sixty-nine patients with chronic low back pain. Outcome measures Socio-demographic variables, education, profession, self-reported measures, degenerative changes on MRI. Methods Linear growth model and Cox regression analysis.Results Five percent had a normal MRI, 14 and 50% had Modic 1 and Modic 2 changes. Modic changes were not significant covariates for the clinical course of pain, function or fear avoidance beliefs. Education was a strong prognostic factor for recovery. Conclusions Modic changes did not influence the clinical course of back pain and were not prognostic factors for recovery. Education was strongly associated with recovery.

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Relationship between degree of separation of endplate cartilage and severity of intervertebral disc herniation

et al. 2021

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Degeneration of intervertebral disc and fissures in the anulus was caused by compression and distraction, which lead to nucleus pulposus herniation. However, controversy remains regarding the exact mechanism behind disc herniation. The aim of this study is to analyze histologically the differences between the three types of disc herniations in an attempt to infer the underlying mechanism. Disc samples extracted from 49 patients who underwent discectomy of the lumbar region were studied by histological analysis. The severity of disc herniation was classified as bulging, protrusion, extrusion, or sequestration based on preoperative magnetic resonance imaging measurements. For comparative analysis of sequestration characteristics, 49 patients were classified into either the sequestration or the non-sequestration group (i.e., protrusion and extrusion) according to disc herniation type. Forty of the 49 patients had cartilage present in their disc samples upon histological analysis. The endplate cartilage-containing samples included two of four (50%) protruded disc patients, 22 of 29 (75.9%) extruded disc patients, and 16 of 16 (100%) sequestrated disc patients and had statistical significance (p = 0.019). There were no significant differences in age, sex, body mass index, length of hospital stays, injection history, surgical methods, and Visual Analog Scale between the sequestration and nonsequestration group (all p > 0.05). Separation of endplate cartilage increased with the severity of disc herniation. Therefore, the mechanism of disc herniation should consider the connection with endplate cartilage as an initiating link in the mechanical failure of intervertebral discs.

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Lumbar Disk Herniation: Correlation of Histologic Findings with Marrow Signal Intensity Changes in Vertebral Endplates at MR Imaging

Abstract: Avulsion-type disk herniation seems to be common, and vertebral endplate marrow signal intensity changes on MR images are indicative of cartilaginous material in the extruded disk herniation material.

Cited by 127 publications

References 28 publications

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

MRI follow-up of subchondral signal abnormalities in a selected group of chronic low back pain patients

Are Modic changes prognostic for recovery in a cohort of patients with non-specific low back pain?

Relationship between degree of separation of endplate cartilage and severity of intervertebral disc herniation

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