Vertebral Endplate Changes Correlate with Presence of Cartilaginous Endplate in the Herniated Disc Tissue: Factor Predicting Failure of Conservative Treatment

Abstract

To characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI). Overview of Literature: Considering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported. Methods: Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19-65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid-Schiff stain; examined for histological degeneration scores (HDS; 0-15), inflammation (0 [absence]-3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-geneproduct 9.5 and expression was counted/mm 2 . Data was analyzed, and p<0.05 was considered to indicate statistical significance. Results: VEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p<0.001) and inflammation (p<0.001). Discs with adjacent Modic changes also revealed increased HDS (p=0.01). Histological sections with CEP showed increased HDS (p<0.001) and inflammation (p<0.001), and nerve density was significantly positively correlated with HDS (r=0.27, p=0.02). Conclusions: VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms.

Update 2023: 10 Jahre Kontroverse um „Modic Changes“

“…Im gleichen Jahr zeigte ein systematisches Review der Literatur zu MC von 2001-2020 eine positive Evidenz für das intradiskale Vorhandensein von C. acnes in Kultur, Mikroskopie und Sequenzierung [14]. Endplattendefekte ("Schmorl-Knoten"), die in den Wirbelkörper eingebrochenem Bandscheibengewebe entsprechen, in den Fokus [16,25], die mit stärkerer Diskusdegeneration und Schmerz assoziiert scheinen [16,[24][25][26].…”

“…Dabei unterschied sich nach Dr. Albert diese Gruppe bezüglich des hohen Ausmaßes an Schmerz und funktionellen Einschränkungen in Klinik und Anamnese von anderen Formen chronischer Rückenschmerzen, bei denen diese spezifischen MRT-Veränderungen nicht nachweisbar waren. Endplattendefekte ("Schmorl-Knoten"), die in den Wirbelkörper eingebrochenem Bandscheibengewebe entsprechen, in den Fokus [16,25], die mit stärkerer Diskusdegeneration und Schmerz assoziiert scheinen [16,[24][25][26].…”

Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain

“…Coexisting facet joint-related pain, with nociception via the medial branch nerves is also possible, particularly given the frequency of disc height loss in patients with vertebrogenic pain, which results in greater facet joint loading at the spinal motion segment [ 31 ]. Indeed, it has been reported that Modic type 1 changes (MC1) and endplate defects commonly co-occur in patients with lumbar disc herniation and associated radiculopathy [ 32 , 33 ], and these findings are associated with higher rates of conservative treatment failure prior to discectomy [ 34 ]. In patients with LSS, endplate defects are a stronger predictor of axial LBP intensity than the severity of the spinal stenosis [ 35 ].…”