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Endplate lesions in the lumbar spine: a novel MRI-based classification scheme and epidemiology in low back pain patients

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Abstract

Purpose

The aims of the study were to introduce a classification scheme for endplate lesions based on T2-weighted magnetic resonance imaging and to detect possible associations between endplate lesions and other variables such as age, sex, disc degeneration and Modic changes in a large population.

Methods

MRI images of 996 low back pain patients were collected. All intervertebral spaces were classified as “normal”, “wavy/irregular”, “notched”, “Schmorl’s node” and “fracture”. The associations between endplate lesions and age, sex, disc degeneration and Modic changes were determined in the considered population.

Results

The most common endplate lesions were “notched” and “Schmorl’s nodes”. The prevalence was higher among the male subjects. In most patients (62.8%), no endplate lesions were detected, with a significant difference between male (57.5%) and female subjects (67.9%) (p < 0.001). Lesions were found to be associated with intervertebral disc degeneration (relative risk 2.49) and signal alterations (relative risk 3.08). Fleiss kappas of 0.73 and 0.89 were, respectively, assessed for the inter- and intra-observer reliabilities of the new classification system.

Conclusions

Endplate lesions were detected, classified with a novel scheme and analysed in a large population of patients suffering from low back pain based on MRI images. The reliability of the novel classification system was demonstrated.

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Authors and Affiliations

  1. Department of Spine Surgery III, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Marco Brayda-Bruno

  2. Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy

    Domenico Albano, Guglielmo Cannella & Alberto Zerbi

  3. Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy

    Fabio Galbusera

Authors
  1. Marco Brayda-Bruno
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  2. Domenico Albano
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  3. Guglielmo Cannella
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  4. Fabio Galbusera
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  5. Alberto Zerbi
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Correspondence to Fabio Galbusera.

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The authors declare that they have no conflict of interest.

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Written informed consent for the use of the data for research purposes was obtained and double anonymization of patients’ data was performed.

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Brayda-Bruno, M., Albano, D., Cannella, G. et al. Endplate lesions in the lumbar spine: a novel MRI-based classification scheme and epidemiology in low back pain patients. Eur Spine J 27, 2854–2861 (2018). https://doi.org/10.1007/s00586-018-5787-6

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  • DOI: https://doi.org/10.1007/s00586-018-5787-6

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