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

European Spine Journal volume 24, pages 2449–2457 (2015)Cite this 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.

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References

  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):108–116

    Article  PubMed  Google Scholar 

  2. Antonacci MD, Mody DR, Heggeness MH (1999) Innervation of the human vertebral body: a histologic study. J Spinal Disord 11(6):526

    Google Scholar 

  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):147–153

    CAS  Article  Google Scholar 

  4. Wang Y, Videman T, Battié MC (2012) Lumbar vertebral endplate lesions: prevalence, classification, and association with age. Spine 37(17):1432–1439

    Article  PubMed  Google Scholar 

  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):71–74

    CAS  PubMed  Google Scholar 

  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):352

    Article  PubMed  Google Scholar 

  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):2711

    Article  PubMed  Google Scholar 

  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):1897

    Article  PubMed  Google Scholar 

  9. Veres SP, Robertson PA, Broom ND (2010) The influence of torsion on disc herniation when combined with flexion. Eur Spine J 19(9):1468–1478

    PubMed Central  Article  PubMed  Google Scholar 

  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):2288

    Article  PubMed  Google Scholar 

  11. Malinin T, Brown M (2007) Changes in vertebral bodies adjacent to acutely narrowed intervertebral discs: observations in baboons. Spine 32(21):E603

    Article  PubMed  Google Scholar 

  12. Rätsep T, Minajeva A, Asser T (2013) Relationship between neovascularization and degenerative changes in herniated lumbar intervertebral discs. Eur Spine J 22:2474–2480

    PubMed Central  Article  PubMed  Google Scholar 

  13. Babar S, Saifuddin A (2002) MRI of the post-discectomy lumbar spine. Clin Radiol 57(11):969–981

    CAS  Article  PubMed  Google Scholar 

  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):273

    Article  PubMed  Google Scholar 

  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):503–505

    CAS  Article  PubMed  Google Scholar 

  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):101–106

    PubMed Central  Article  PubMed  Google Scholar 

  17. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26(17):1873–1878

    CAS  Article  PubMed  Google Scholar 

  18. Modic M, Masaryk T, Ross J, Carter J (1988) Imaging of degenerative disk disease. Radiology 168(1):177

    CAS  Article  PubMed  Google Scholar 

  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):1943–1946

    Article  PubMed  Google Scholar 

  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):968–974

    Article  PubMed  Google Scholar 

  21. Hilton RC, Ball J, Benn RT (1976) Vertebral end-plate lesions (Schmorl’s nodes) in the dorsolumbar spine. Ann Rheum Dis 35(2):127–132

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  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):879

    CAS  Google Scholar 

  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):368–374

    CAS  Article  PubMed  Google Scholar 

  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 145:87

    PubMed Central  CAS  PubMed  Google Scholar 

  25. Silberstein M, Opeskin K, Fahey V (1999) Spinal Schmorl’s nodes: sagittal sectional imaging and pathological examination. Australas Radiol 43(1):27–30

    CAS  Article  PubMed  Google Scholar 

  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):216–222

    Article  Google Scholar 

  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):212–219

    Article  Google Scholar 

  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):1714

    Article  PubMed  Google Scholar 

  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):2271–2279

    PubMed Central  Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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):E596

    PubMed  Google Scholar 

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Conflict of interest

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

Author information

Affiliations

  1. Department of Orthopaedic Surgery, The Methodist Hospital, Houston, TX, USA

    Bradley K. Weiner & Joseph Fernandez-Moure

  2. Klinicka Bolnica Dubrava, Zagreb, Croatia

    Milorad Vilendecic

  3. KBC Rijeka, Rijeka, Croatia

    Darko Ledic

  4. University Clinic for Neurosurgery, University Hospital and Medical University, Graz, Austria

    Sandro Eustacchio

  5. National Center for Spinal Disorders, Budapest, Hungary

    Peter Varga

  6. Orthopedic Clinic Ljubljana, Ljubljana, Slovenia

    Miro Gorensek

  7. Medical Metrics, Research, 2121 Sage Rd, Suite 300, Houston, TX, 77056, USA

    John A. Hipp

Authors
  1. Bradley K. Weiner
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  2. Milorad Vilendecic
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  3. Darko Ledic
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  4. Sandro Eustacchio
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  5. Peter Varga
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  6. Miro Gorensek
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  7. Joseph Fernandez-Moure
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  8. John A. Hipp
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Correspondence to John A. Hipp.

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Weiner, B.K., Vilendecic, M., Ledic, D. et al. Endplate changes following discectomy: natural history and associations between imaging and clinical data. Eur Spine J 24, 2449–2457 (2015). https://doi.org/10.1007/s00586-014-3734-8

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  • DOI: https://doi.org/10.1007/s00586-014-3734-8

Keywords

  • Lumbar discectomy
  • Endplate changes
  • Imaging
  • Clinical outcomes