Advertisement

European Spine Journal

, Volume 24, Issue 11, pp 2449–2457 | Cite as

Endplate changes following discectomy: natural history and associations between imaging and clinical data

  • Bradley K. Weiner
  • Milorad Vilendecic
  • Darko Ledic
  • Sandro Eustacchio
  • Peter Varga
  • Miro Gorensek
  • Joseph Fernandez-Moure
  • John A. HippEmail author
Original Article

Abstract

Purpose

Some patients will experience post-operative back pain following lumbar discectomy, and the potential sources for that pain are poorly understood. One potential source is the vertebral endplates. The goal of this study was to document the changes that occur in lumbar endplates following discectomies, and to assess associations between endplate changes and clinical outcomes.

Methods

Changes in lumbar endplates and discs were assessed from X-rays, CT and MRI exams by comparing preoperative imaging with imaging obtained at yearly intervals up to 5 years. 260 endplates in 137 patients with single-level herniation and discectomy were analyzed. The geometry of osseous defects in the endplates was measured from the CT exams, and marrow and disc changes adjacent to endplates were assessed from the MRI exams. Clinical outcome assessments were collected at each time point. Descriptive statistics were used to describe endplate defect sizes, and logistic regression and analysis of variance were used to identify potential associations between endplate and vertebral body changes and clinical outcomes.

Results

Approximately 14 % of the endplates had osseous defects prior to surgery. After surgery, 24 % of inferior and 43 % of superior endplates had defects. Change occurred within the first year and remained relatively constant over the next few years. Disc signal intensity worsened and disc height decreased following surgery. New Modic changes were also observed. None of these changes were associated with having achieved a clinically significant improvement in outcome scores. The follow-up rates were low at the later time points and significant associations cannot be ruled out.

Conclusions

This study documents lesion characteristics in detail and supports that osseous defects in the endplates at the level of a lumbar discectomy may be a relatively common finding following surgery, along with disc height loss, loss of disc signal intensity, and Modic changes. The clinical significance of these imaging findings could not be conclusively determined in this study.

Keywords

Lumbar discectomy Endplate changes Imaging Clinical outcomes 

Notes

Conflict of interest

Patient follow-up and data analysis were supported by Intrinsic Therapeutics, Inc.

References

  1. 1.
    Sherman J, Cauthen J, Schoenberg D, Burns M, Reaven NL, Griffith SL (2010) Economic impact of improving outcomes of lumbar discectomy. Spine J 10(2):108–116CrossRefPubMedGoogle Scholar
  2. 2.
    Antonacci MD, Mody DR, Heggeness MH (1999) Innervation of the human vertebral body: a histologic study. J Spinal Disord 11(6):526Google Scholar
  3. 3.
    Brown MF, Hukkanen MV, McCarthy ID, Redfern DR, Batten JJ, Crock HV, Hughes SP, Polak JM (1997) Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease. J Bone Jt Surg Br 79(1):147–153CrossRefGoogle Scholar
  4. 4.
    Wang Y, Videman T, Battié MC (2012) Lumbar vertebral endplate lesions: prevalence, classification, and association with age. Spine 37(17):1432–1439CrossRefPubMedGoogle Scholar
  5. 5.
    Bonneville JF, Runge M, Cattin F, Potelon P, Tang YS (1989) Extraforaminal lumbar disc herniations: CT demonstration of Sharpey’s fibers avulsion. Neuroradiology 31(1):71–74PubMedGoogle Scholar
  6. 6.
    Schmid G, Witteler A, Willburger R, Kuhnen C, Jergas M, Koester O (2004) Lumbar Disk Herniation: correlation of Histologic Findings with Marrow Signal Intensity Changes in Vertebral Endplates at MR Imaging 1. Radiology 231(2):352CrossRefPubMedGoogle Scholar
  7. 7.
    Veres SP, Robertson PA, Broom ND (2008) ISSLS prize winner: microstructure and mechanical disruption of the lumbar disc annulus: part II: how the annulus fails under hydrostatic pressure. Spine 33(25):2711CrossRefPubMedGoogle Scholar
  8. 8.
    Veres SP, Robertson PA, Broom ND (2010) ISSLS Prize Winner: how loading rate influences disc failure mechanics: a microstructural assessment of internal disruption. Spine 35(21):1897CrossRefPubMedGoogle Scholar
  9. 9.
    Veres SP, Robertson PA, Broom ND (2010) The influence of torsion on disc herniation when combined with flexion. Eur Spine J 19(9):1468–1478PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Veres SP, Robertson PA, Broom ND (2009) The morphology of acute disc herniation: a clinically relevant model defining the role of flexion. Spine 34(21):2288CrossRefPubMedGoogle Scholar
  11. 11.
    Malinin T, Brown M (2007) Changes in vertebral bodies adjacent to acutely narrowed intervertebral discs: observations in baboons. Spine 32(21):E603CrossRefPubMedGoogle Scholar
  12. 12.
    Rätsep T, Minajeva A, Asser T (2013) Relationship between neovascularization and degenerative changes in herniated lumbar intervertebral discs. Eur Spine J 22:2474–2480PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Babar S, Saifuddin A (2002) MRI of the post-discectomy lumbar spine. Clin Radiol 57(11):969–981CrossRefPubMedGoogle Scholar
  14. 14.
    Barth M, Diepers M, Weiss C, ThomÈ C (2008) Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Spine 33(3):273CrossRefPubMedGoogle Scholar
  15. 15.
    Grand C, Bank W, Baleriaux D, Matos C, Levivier M, Brotchi J (1993) Gadolinium enhancement of vertebral endplates following lumbar disc surgery. Neuroradiology 35(7):503–505CrossRefPubMedGoogle Scholar
  16. 16.
    Oetgen M, Yue J, Jaramillo-de la Torre J, Bertagnoli R (2008) Does Vertebral Endplate Morphology Influence Outcomes in Lumbar Total Disc Arthroplasty?: Part II: Clinical and Radiographic Results as Evaluated Utilizing the Vertebral Endplate Yue-Bertagnoli (VEYBR) Classification. SAS J 2(2):101–106PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26(17):1873–1878CrossRefPubMedGoogle Scholar
  18. 18.
    Modic M, Masaryk T, Ross J, Carter J (1988) Imaging of degenerative disk disease. Radiology 168(1):177CrossRefPubMedGoogle Scholar
  19. 19.
    Zhao KD, Yang C, Zhao C, Stans AA, An KN (2005) Assessment of non-invasive intervertebral motion measurements in the lumbar spine. J Biomech 38(9):1943–1946CrossRefPubMedGoogle Scholar
  20. 20.
    Copay AG, Glassman SD, Subach BR, Berven S, Schuler TC, Carreon LY (2008) Minimum clinically important difference in lumbar spine surgery patients: a choice of methods using the Oswestry Disability Index, Medical Outcomes Study questionnaire Short Form 36, and pain scales. Spine J 8(6):968–974CrossRefPubMedGoogle Scholar
  21. 21.
    Hilton RC, Ball J, Benn RT (1976) Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 35(2):127–132PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Peng B, Wu W, Hou S, Shang W, Wang X, Yang Y (2003) The pathogenesis of Schmorl’s nodes. J Bone Jt Surg Br 85(6):879Google Scholar
  23. 23.
    Pfirrmann CW, Resnick D (2001) Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1,650 spinal levels in 100 cadavers. Radiology 219(2):368–374CrossRefPubMedGoogle Scholar
  24. 24.
    Saluja G, Fitzpatrick K, Bruce M, Cross J (1986) Schmorl’s nodes (intravertebral herniations of intervertebral disc tissue) in two historic British populations. J Anat 145:87PubMedCentralPubMedGoogle Scholar
  25. 25.
    Silberstein M, Opeskin K, Fahey V (1999) Spinal Schmorl’s nodes: sagittal sectional imaging and pathological examination. Australas Radiol 43(1):27–30CrossRefPubMedGoogle Scholar
  26. 26.
    Girard C, Schweitzer M, Morrison W, Parellada J, Carrino J (2004) Thoracic spine disc-related abnormalities: longitudinal MR imaging assessment. Skelet Radiol 33(4):216–222CrossRefGoogle Scholar
  27. 27.
    Wu H, Morrison W, Schweitzer M (2006) Edematous Schmorl’s nodes on thoracolumbar MR imaging: characteristic patterns and changes over time. Skelet Radiol 35(4):212–219CrossRefGoogle Scholar
  28. 28.
    Kuisma M, Karppinen J, Niinimäki J, Kurunlahti M, Haapea M, Vanharanta H, Tervonen O (2006) A 3-year follow-up of lumbar spine endplate (Modic) changes. Spine 31(15):1714CrossRefPubMedGoogle Scholar
  29. 29.
    Jensen RK, Leboeuf-Yde C, Wedderkopp N, Sorensen JS, Jensen TS, Manniche C (2012) Is the development of Modic changes associated with clinical symptoms? A 14-month cohort study with MRI. Eur Spine J 21(11):2271–2279PubMedCentralCrossRefPubMedGoogle Scholar
  30. 30.
    Rahme R, Moussa R, Bou-Nassif R, Maarrawi J, Rizk T, Nohra G, Samaha E, Okais N (2010) What happens to Modic changes following lumbar discectomy? Analysis of a cohort of 41 patients with a 3- to 5-year follow-up period. J Neurosurg Spine 13(5):562–567. doi: 10.3171/2010.5.SPINE09818 CrossRefPubMedGoogle Scholar
  31. 31.
    Ohtori S, Yamashita M, Yamauchi K, Inoue G, Koshi T, Suzuki M, Orita S, Eguchi Y, Ochiai N, Kishida S (2010) Low back pain after lumbar discectomy in patients showing endplate Modic type 1 change. Spine 35(13):E596PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Bradley K. Weiner
    • 1
  • Milorad Vilendecic
    • 2
  • Darko Ledic
    • 3
  • Sandro Eustacchio
    • 4
  • Peter Varga
    • 5
  • Miro Gorensek
    • 6
  • Joseph Fernandez-Moure
    • 1
  • John A. Hipp
    • 7
    Email author
  1. 1.Department of Orthopaedic SurgeryThe Methodist HospitalHoustonUSA
  2. 2.Klinicka Bolnica DubravaZagrebCroatia
  3. 3.KBC RijekaRijekaCroatia
  4. 4.University Clinic for Neurosurgery, University Hospital and Medical UniversityGrazAustria
  5. 5.National Center for Spinal DisordersBudapestHungary
  6. 6.Orthopedic Clinic LjubljanaLjubljanaSlovenia
  7. 7.Medical Metrics, ResearchHoustonUSA

Personalised recommendations