European Spine Journal

, Volume 24, Issue 4, pp 679–685 | Cite as

Association between intervertebral disc degeneration and endplate perfusion studied by DCE-MRI

  • L. Tugan Muftuler
  • Joshua P. Jarman
  • Hon J. Yu
  • Vance O. Gardner
  • Dennis J. Maiman
  • Volkan Emre Arpinar
Original Article
First Online:
Received:
Revised:
Accepted:

Abstract

Purpose

The goal of this study was to study the association between solute transport mechanisms in cartilaginous disc endplates and the degeneration of intervertebral discs. Intervertebral disc degeneration is a multi-factorial process. It is suspected that poor nutrient delivery to discs might be a factor leading to degeneration. Several studies suggest that defects in disc endplates could lead to poor transport of nutrients. An imaging technique assessing endplate perfusion could be a valuable tool in investigating disc degeneration. There is currently no universally accepted technique assessing endplate perfusion in vivo.

Methods

Nine adult patients exhibiting varying levels of intervertebral disc degeneration were included. MRI was used to study the association between blood perfusion in 90 lumbar disc endplates and disc degeneration in 45 lumbar discs. Solute transport mechanism through endplates was assessed indirectly by dynamic contrast enhanced (DCE) MRI. T2-weighted MRI was used for conventional Pfirrmann classification.

Results

A positive association was observed between Pfirrmann grades and endplate DCE-MRI enhancement. A differential enhancement between cranial and caudal endplates was also observed, which increased with Pfirrmann grades. This differential enhancement was also dependent on the lumbar level.

Conclusions

Increased MRI signal enhancement in the cartilaginous endplates of degenerated discs might indicate damage to the subchondral bone of the vertebral bodies. The endplate enhancement characteristic could aid in understanding the pathophysiology of disc degeneration and planning treatment more effectively.

Keywords

Intervertebral disc degeneration Intervertebral disc endplates Endplate degeneration Endplate solute transport DCE-MRI 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

This study is supported in part by funds from Advancing a Healthier Wisconsin FP00002161, AOSpine Clinical Priority program and also from Orthopedic Education and Research Institute of Southern California, a non-profit research institute which received funds from Cardiovascular BioTherapeutics Inc. We also would like to thank Aniko Szabo, Ph.D. and Qun Xiang, M.Sc. from the Division of Biostatistics, Institute for Health and Society at MCW for their assistance in statistical analyses.

Conflict of interest

None of the authors has any potential conflict of interest.

Ethical standard

This study was approved by the Institutional Review Board of the University of California, Irvine, where the study was conducted.

References

  1. 1.
    Roh JS, Teng AL, Yoo JU, Davis J, Furey C, Bohlman HH (2005) Degenerative disorders of the lumbar and cervical spine. Orthop Clin North Am 36:255–262CrossRefPubMedGoogle Scholar
  2. 2.
    Patel AA, Spiker WR, Daubs M, Brodke D, Cannon-Albright LA (2011) Evidence for an inherited predisposition to lumbar disc disease. J Bone Joint Surg Am 93:225–229CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Miller TT (2004) Imaging of disk disease and degenerative spondylosis of the lumbar spine. Semin Ultrasound CT MR 25:506–522CrossRefPubMedGoogle Scholar
  4. 4.
    Peng B, Hao J, Hou S, Wu W, Jiang D, Fu X, Yang Y (2006) Possible pathogenesis of painful intervertebral disc degeneration. Spine 31:560–566CrossRefPubMedGoogle Scholar
  5. 5.
    An HS, Anderson PA, Haughton VM, Iatridis JC, Kang JD, Lotz JC, Natarajan RN, Oegema TRJ, Roughley P, Setton LA, Urban JP, Videman T, Andersson GB, Weinstein JN (2004) Introduction: disc degeneration: summary. Spine (Phila Pa 1976) 29:2677–2678CrossRefGoogle Scholar
  6. 6.
    Adams MA, Roughley PJ (2006) What is intervertebral disc degeneration, and what causes it? Spine (Phila Pa 1976) 31:2151–2161CrossRefGoogle Scholar
  7. 7.
    Boos N, Weissbach S, Rohrbach H, Weiler C, Spratt KF, Nerlich AG (2002) Classification of age-related changes in lumbar intervertebral discs: 2002 Volvo Award in basic science. Spine (Phila Pa 1976) 27:2631–2644CrossRefGoogle Scholar
  8. 8.
    Crock HV, Goldwasser M (1984) Anatomic studies of the circulation in the region of the vertebral end-plate in adult Greyhound dogs. Spine (Phila Pa 1976) 9:702–706CrossRefGoogle Scholar
  9. 9.
    Van DWM, Lezuo P, Maissen O, Van DCC, Ito K (2007) Inhibition of vertebral endplate perfusion results in decreased intervertebral disc intranuclear diffusive transport. J Anat 211:769–774CrossRefGoogle Scholar
  10. 10.
    Modic MT, Ross JS (2007) Lumbar degenerative disk disease. Radiology 245:43–61CrossRefPubMedGoogle Scholar
  11. 11.
    Rajasekaran S, Babu JN, Arun R, Armstrong BR, Shetty AP, Murugan S (2004) ISSLS prize winner: a study of diffusion in human lumbar discs: a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs. Spine 29:2654–2667CrossRefPubMedGoogle Scholar
  12. 12.
    Rajasekaran S, Venkatadass K, Naresh BJ, Ganesh K, Shetty AP (2008) Pharmacological enhancement of disc diffusion and differentiation of healthy, ageing and degenerated discs : results from in vivo serial post-contrast MRI studies in 365 human lumbar discs. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc 17:626–643CrossRefGoogle Scholar
  13. 13.
    Shirazi-Adl A, Taheri M, Urban JP (2010) Analysis of cell viability in intervertebral disc: effect of endplate permeability on cell population. J Biomech 43:1330–1336CrossRefPubMedGoogle Scholar
  14. 14.
    Ayotte DC, Ito K, Perren SM, Tepic S (2000) Direction-dependent constriction flow in a poroelastic solid: the intervertebral disc valve. J Biomech Eng 122:587–593CrossRefPubMedGoogle Scholar
  15. 15.
    Ayotte DC, Ito K, Tepic S (2001) Direction-dependent resistance to flow in the endplate of the intervertebral disc: an ex vivo study. J Orthop Res Off Publ Orthop Res Soc 19:1073–1077CrossRefGoogle Scholar
  16. 16.
    Mcauliffe MJ, Lalonde FM, Mcgarry D, Gandler W, Csaky K, Trus BL (2001) Medical image processing, analysis and visualization in clinical research. In: Proceedings. 14th IEEE Symposium on Computer-Based Medical Systems, 381–386Google Scholar
  17. 17.
    Bae WC, Xu K, Hemmad AR, Inoue N, Bydder GM, Chung CB, Masuda K (2010) Stockholm, Sweden. Ultrashort time-to-echo MRI of human intervertebral disc endplate: association with endplate calcification. In: Proceedings of the International Society of Magnetic Resonance in Medicine, 3218Google Scholar
  18. 18.
    Massey CJ, Van DCC, Vresilovic E, Zavaliangos A, Marcolongo M (2012) Effects of aging and degeneration on the human intervertebral disc during the diurnal cycle: a finite element study. J Orthop Res Off Publ Orthop Res Soc 30:122–128CrossRefGoogle Scholar
  19. 19.
    Benneker LM, Heini PF, Alini M, Anderson SE, Ito K (2005) 2004 Young Investigator Award Winner: vertebral endplate marrow contact channel occlusions and intervertebral disc degeneration. Spine 30:167–173CrossRefPubMedGoogle Scholar
  20. 20.
    Motaghinasab S, Shirazi-Adl A, Urban JP, Parnianpour M (2012) Computational pharmacokinetics of solute penetration into human intervertebral discs—effects of endplate permeability, solute molecular weight and disc size. J Biomech 45:2195–2202CrossRefPubMedGoogle Scholar
  21. 21.
    Rodriguez AG, Rodriguez-Soto AE, Burghardt AJ, Berven S, Majumdar S, Lotz JC (2012) Morphology of the human vertebral endplate. J Orthop Res Off Publ Orthop Res Soc 30:280–287CrossRefGoogle Scholar
  22. 22.
    Dolan P, Luo J, Pollintine P, Landham PR, Stefanakis M, Adams MA (2013) Intervertebral disc decompression following endplate damage: implications for disc degeneration depend on spinal level and age. Spine 38:1473–1481CrossRefPubMedGoogle Scholar
  23. 23.
    Hulme PA, Boyd SK, Ferguson SJ (2007) Regional variation in vertebral bone morphology and its contribution to vertebral fracture strength. Bone 41:946–957CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • L. Tugan Muftuler
    • 1
    • 2
  • Joshua P. Jarman
    • 3
  • Hon J. Yu
    • 4
  • Vance O. Gardner
    • 5
  • Dennis J. Maiman
    • 1
  • Volkan Emre Arpinar
    • 1
  1. 1.Department of Neurosurgery, Medical College of WisconsinFroedtert HospitalMilwaukeeUSA
  2. 2.Center for Imaging ResearchMedical College of WisconsinMilwaukeeUSA
  3. 3.Medical College of WisconsinMilwaukeeUSA
  4. 4.Department of Radiological Sciences and Center for Functional Onco-ImagingUniversity of CaliforniaIrvineUSA
  5. 5.Orthopaedic Education and Research Institute of Southern CaliforniaOrangeUSA

Personalised recommendations