Multidimensional vertebral endplate defects are associated with disc degeneration, modic changes, facet joint abnormalities, and pain

Abstract

The aim of the current study was to investigate the multi-dimensional characteristics of lumbar endplate defects in humans in relation to disc degeneration and other MRI phenotypes as well as their role with pain and disability. A total of 108 subjects were recruited and underwent 3T MRI of the lumbar spine. Structural endplate defects were identified and their dimensions were measured in terms of maximum width and depth, and were then standardized to the actual width of the endplate and depth of the vertebral body, respectively. Both width and depth of all endplate defects in each subject were added separately and scores were assigned on the basis of size from 1 to 3. Combining both scores provided "cumulative endplate defect scores." Disc degeneration scores, Modic changes, disc displacement, HIZ, and facet joint changes were assessed. Subject demographics, pain profile, and Oswestry Disability Index (ODI) were also obtained. Endplate defects were observed in 67.5% of the subjects and in 13.5% of the endplates. All dimensions of endplate defects showed significance with disc degenerative scores, Modic changes, and posterior disc displacement (p < 0.05). Maximum width (p ¼ 0.009) and its standardized value (p ¼ 0.02), and cumulative endplate defect scores (p ¼ 0.004) increased with narrow facet joints. Cumulative endplate defect scores showed a strong positive association with ODI (p < 0.05) compared to disc degenerative scores. Large size endplate defects were strongly associated with degenerative spine changes and more back-related disability. Findings from this study stress the need to assess endplate findings from a multi-dimensional perspective, whose role may have clinical utility. ß 2019 Orthopaedic Research

New insights into the natural course and clinical relevance of Modic changes over 2 years following lumbar limited discectomy: analysis of prospective collected data

“…However, their prevalence is questionable. Some found endplate defects in two-thirds of their investigated cohort (108 patients) and showed a significance with disc degeneration scores, MC, and posterior disc displacement [21]. Others detected no endplate lesions in the whole lumbar spine in nearly two-thirds of 996 low back pain patients investigated with MRI [22].…”

The Impact of Modic Changes on Preoperative Symptoms and Clinical Outcomes in Anterior Cervical Discectomy and Fusion Patients

“…Conversely, this finding could suggest that the present study was underpowered to determine the true postoperative effect size of MC at other cervical segments. In a previous study, Zehra et al 35 noted that the relationship between lumbar spine endplate defects (such as MC) and patient-reported pain and disability is highly correlated. However, what effect preoperative MC may have on subjective postoperative outcomes remains a topic of debate.…”

Correlation between lumbar sagittal alignment, Modic changes, and endplate erosion in patients with degenerative disease

“…Type 3 endplate defect, erosive endplate defect, observed as the extensively irregular, serrated, or worm-eaten appearance. [14]Inter-rater agreement for the coding of endplate defect was calculated using Cohen's weighted kappa and Pearson's correlation.…”

“…MCs are frequently observed inpathological structure changes like disc degeneration, disc herniation, and endplate defect. [5][6][7] A recent study demonstrated that there is an association between endplate defect and disc degeneration in a large-scale, population-based study. Several theories have been proposed with respect to the etiology of MCs and endplate defect.…”