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Structural vertebral endplate nomenclature and etiology: a study by the ISSLS Spinal Phenotype Focus Group

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Abstract

Purpose

Vertebral endplate abnormalities may be associated with disc degeneration and, perhaps, pain generation. However, consensus definitions for endplate findings on spine MRI do not exist, posing a challenge to compare findings between studies and ethnic groups. The following survey was created to characterize the variability among the global spine community regarding endplate structural findings with respect to nomenclature and etiology.

Methods

A working group within the International Society for the Study of the Lumbar Spine (ISSLS) Spinal Phenotype Focus Group was established to assess the endplate phenotype. A survey which consisted of 13 T2-weighted sagittal MRIs of the human lumbar spine illustrating the superior and inferior endplates was constructed based on discussion and agreement by the working group. A list of nomenclature and etiological terms with historical precedence was generated. Participants were asked to describe the endplates of each image and select from 14 possible nomenclatures and 10 etiological terms along with the option of free text response. The survey was entered into RedCap and was circulated throughout the ISSLS membership for data capture. Participants’ demographics were also noted.

Results

The survey was completed by 55 participants (87% males; 85% above 45 years of age, 39 clinicians, and 16 researchers). Sixty-eight percent of researchers and seventy-four percent of clinicians reported more than 16 and 20 years of research and clinical experience. Considerable variation existed in selection of nomenclature, etiology, and degree of severity of the endplate structural findings (reliability coefficients for single measures in each case were 0.3, 0.08, and 0.2, respectively). Sixty-seven percent regarded Modic changes as being a structural endplate finding. Approximately 84 and 80% of clinicians and researchers, respectively, agreed that a standardized endplate nomenclature and understanding the etiology is clinically important and needed.

Conclusions

This study found that variations exist with respect to endplate nomenclature and etiology between clinicians and basic scientists, and paves the way for a consensus process to formalize the definitions.

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Authors and Affiliations

  1. Department of Orthopedics and Traumatology, The University of Hong Kong, Professorial Block, 5th Floor, 102 Pokfulam Road, Pokfulam, Hong Kong, SAR, China

    Uruj Zehra, Cora Bow, Keith D. K. Luk & Dino Samartzis

  2. Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA

    Jeffrey C. Lotz

  3. Division of Genetics and Molecular Medicine, King’s College London, London, UK

    Frances M. K. Williams

  4. Department of Orthopedics and Spine Surgery, Ganga Hospital, Coimbatore, India

    S. Rajasekaran

  5. Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland

    Jaro Karppinen

  6. Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada

    Michele C. Battiê

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  1. Uruj Zehra
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  2. Cora Bow
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  3. Jeffrey C. Lotz
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  4. Frances M. K. Williams
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  5. S. Rajasekaran
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  7. Keith D. K. Luk
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  8. Michele C. Battiê
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  9. Dino Samartzis
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Correspondence to Dino Samartzis.

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The authors have no financial or competing interests to disclose.

Funding

This work was supported by grants from the Hong Kong Theme-Based Research Scheme (T12-708/12N), Hong Kong Research Grants Council (777111), and the International Society for the Study of the Lumbar Spine MacNab/LaRocca Award.

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Zehra, U., Bow, C., Lotz, J.C. et al. Structural vertebral endplate nomenclature and etiology: a study by the ISSLS Spinal Phenotype Focus Group. Eur Spine J 27, 2–12 (2018). https://doi.org/10.1007/s00586-017-5292-3

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  • DOI: https://doi.org/10.1007/s00586-017-5292-3

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