European Spine Journal

, Volume 27, Issue 8, pp 1704–1711 | Cite as

Intervertebral disc status is associated with vertebral marrow adipose tissue and muscular endurance

  • Matthew Quittner
  • Timo Rantalainen
  • Nicola D. Ridgers
  • Guy Trudel
  • Adnan Sheikh
  • David Connell
  • Daniel L. Belavý
Original Article



Low back pain is a major public health issue. Identifying factors associated with better intervertebral disc (IVD) characteristics gives insight into IVD metabolism and highlights intervention targets for improvement of IVD health. This cross-sectional study investigates whether IVD T2-relaxation time on magnetic resonance imaging (MRI) is associated with vertebral fat fraction (VFF; to quantify marrow adipose tissue), trunk muscle cross-sectional area (CSA), muscle function and physical activity (PA).


Seventy-nine healthy subjects (35 males, 44 females) without history of spinal disease were included. Lumbar IVDs T2-relaxation time, lumbar VFF and CSA of multifidus, erector spinae, quadratus lumborum, and psoas muscles were quantified via MRI. Isometric trunk flexion and extension endurance times as well as habitual PA levels and exposure to occupational spine risk factors were documented. Pearson-partial correlations adjusted for anthropometric differences by controlling for vertebral body height.


Higher IVD T2-time correlated with: (a) lower VFF (r = − 0.27, p < 0.05), (b) greater trunk extensor muscle endurance (r = 0.37, p < 0.01), and (c) greater trunk flexor muscle endurance (r = 0.30, p < 0.01) but not with muscle CSA. Lower VFF also correlated with greater extensor muscle endurance (r = − 0.26, p < 0.05) and habitual PA (MET-mins per week) (r = − 0.24, p < 0.05).


This is the first study to show that better IVD hydration is associated with lower VFF and that greater physical activity is associated with favourable levels of vertebral marrow adipose tissue in young healthy individuals. Reduced vertebral marrow adipose tissue may specifically improve IVD hydration via improved nutrient supply.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Intervertebral disc Exercise Marrow adipose tissue Magnetic resonance imaging Muscular endurance 



The authors wish to thank the individuals who participated in this study, the staff at Imaging@OlympicPark, and the colleagues involved in the implementation of the Spine and Physical Activity Study.


This project was supported by the School of Exercise and Nutrition Sciences, Deakin University (Grant ID: Belavy 2014-2017).

Compliance with ethical standards

Conflict of interest

All authors declare they have no conflicts of interest.

IRB approval/research ethics committee

Deakin University Human Ethics Advisory Group.

Supplementary material

586_2018_5567_MOESM1_ESM.pptx (138 kb)
Supplementary material 1 (PPTX 138 kb)
586_2018_5567_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOCX 21 kb)
586_2018_5567_MOESM3_ESM.docx (21 kb)
Supplementary material 3 (DOCX 21 kb)


  1. 1.
    Murray CJ, Vos T, Lozano R et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223CrossRefPubMedGoogle Scholar
  2. 2.
    Cheung KM, Karppinen J, Chan D et al (2009) Prevalence and pattern of lumbar magnetic resonance imaging changes in a population study of one thousand forty-three individuals. Spine 34(9):934–940CrossRefPubMedGoogle Scholar
  3. 3.
    de Schepper EI, Damen J, van Meurs JB et al (2010) The association between lumbar disc degeneration and low back pain the influence of age, gender, and individual radiographic features. Spine 35(5):531–536CrossRefPubMedGoogle Scholar
  4. 4.
    Moore RJ, Crotti TN, Osti OL et al (1999) Osteoarthritis of the facet joints resulting from anular rim lesions in sheep lumbar discs. Spine 24(6):519–525CrossRefPubMedGoogle Scholar
  5. 5.
    Hangai M, Kaneoka K, Kuno S et al (2008) Factors associated with lumbar intervertebral disc degeneration in the elderly. Spine J 8(5):732–740CrossRefPubMedGoogle Scholar
  6. 6.
    Pfirrmann CW, Metzdorf A, Zanetti M et al (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine 26(17):1873–1878CrossRefPubMedGoogle Scholar
  7. 7.
    Belavý DL, Albracht K, Bruggemann GP et al (2016) Can exercise positively influence the intervertebral disc? Sports Med 46(4):473–485CrossRefPubMedGoogle Scholar
  8. 8.
    Marinelli NL, Haughton VM, Muñoz A et al (2009) T2 relaxation times of intervertebral disc tissue correlated with water content and proteoglycan content. Spine 34(5):520–524CrossRefPubMedGoogle Scholar
  9. 9.
    Urban JP, Smith S, Fairbank JC (2004) Nutrition of the intervertebral disc. Spine 29(23):2700–2709CrossRefPubMedGoogle Scholar
  10. 10.
    Horner HA, Urban JP (2001) Effect of nutrient supply on the viability of cells from the nucleus pulposus of the intervertebral disc. Spine 26(23):2543–2549CrossRefPubMedGoogle Scholar
  11. 11.
    Griffith JF, Yeung DK, Antonio GE et al (2005) Vertebral bone mineral density, marrow perfusion, and fat content in healthy men and men with osteoporosis: dynamic contrast-enhanced MR imaging and MR spectroscopy. Radiology 236:945–951CrossRefPubMedGoogle Scholar
  12. 12.
    Griffith JF, Yeung DK, Antonio GE et al (2006) Vertebral marrow fat content and diffusion and perfusion indexes in women with varying bone density: MR evaluation. Radiology 241:831–838CrossRefPubMedGoogle Scholar
  13. 13.
    Vrselja Z, Curic G (2017) Vertebral marrow adipose tissue adipokines as a possible cause of intervertebral disc inflammation. Jt Bone Spine (epub ahead of print) Google Scholar
  14. 14.
    Benneker LM, Heini PF, Alini M et al (2005) 2004 Young Investigator Award Winner: vertebral endplate marrow contact channel occlusions and intervertebral disc degeneration. Spine 30(2):167–173CrossRefPubMedGoogle Scholar
  15. 15.
    Moorhouse KM, Granata KP (2005) Trunk stiffness and dynamics during active extension exertions. J Biomech 38(10):2000–2007CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Woohyung L, Yoonmi L, Wontae G (2011) The effect of lumbar strengthening exercise on pain and the cross-sectional area change of lumbar muscles. J Phys Ther Sci 23(2):209–212CrossRefGoogle Scholar
  17. 17.
    Jensen TS, Karppinen J, Sorenson JS et al (2008) Vertebral endplate signal changes (Modic change): a systematic literature review of prevalence and association with non-specific low back pain. Eur Spine J 17(11):1407–1422CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Fortin M, Yuan Y, Battie MC (2013) Factors associated with paraspinal muscle asymmetry in size and composition in a general population sample of men. Phys Ther 93(11):1540–1550CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Belavý DL, Quittner MJ, Ridgers ND et al (2017) Running exercise strengthens the intervertebral disc. Sci Rep 7:49575CrossRefGoogle Scholar
  20. 20.
    Belavý DL, Quittner MJ, Ridgers ND et al (2018) Specific modulation of vertebral marrow adipose tissue by physical activity. J Bone Miner Res (epub ahead of print) Google Scholar
  21. 21.
    Belavý DL, Quittner MJ, Ling Y et al (2018) Cervical and thoracic intervertebral disc hydration increases with recumbency: a study in 101 healthy volunteers. Spine J 18(2):314–320CrossRefPubMedGoogle Scholar
  22. 22.
    Craig CL, Marshall AL, Sjostrom M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35(8):1381–1395CrossRefPubMedGoogle Scholar
  23. 23.
    NIOSH (1997) Low-back musculoskeletal disorders: evidence for work-relatedness. In: Musculoskeletal disorders and workplace factors: a critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back (Internet). National Institute for Occupational Safety and Health, chap 6. Accessed 15 Dec 2016
  24. 24.
    Ito T, Shirado O, Suzuki H et al (1996) Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation. Arch Phys Med Rehabil 77(1):75–79CrossRefPubMedGoogle Scholar
  25. 25.
    MacLaughlin SM, Oldale KN (1992) Vertebral body diameters and sex prediction. Ann Hum Biol 19(3):285–292CrossRefPubMedGoogle Scholar
  26. 26.
    Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral bone marrow with MR imaging. Radiology 166(1):193–199CrossRefPubMedGoogle Scholar
  27. 27.
    Dudli S, Sing DC, Hu SS et al (2017) ISSLS prize in basic science 2017: intervertebral disc/bone marrow cross-talk with Modic changes. Eur Spine J 26(5):1362–1373CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Małkiewicz A, Dziedzic M (2012) Bone marrow reconversion—imaging of physiological changes in bone marrow. Pol J Radiol 77(4):45–50CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Yuki A, Yotani K, Tamaki H et al (2010) Upregulation of osteogenic factors induced by high-impact jumping suppresses adipogenesis in marrow but not adipogenic transcription factors in rat tibiae. Eur J Appl Physiol 109(4):641–650CrossRefPubMedGoogle Scholar
  30. 30.
    Modic MT (2007) Modic type 1 and type 2 changes. J Neurosurg Spine 6:150–151CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Deakin UniversityGeelongAustralia
  2. 2.Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition SciencesDeakin UniversityBurwoodAustralia
  3. 3.Physical Medicine and Rehabilitation, Faculty of MedicineUniversity of OttawaOttawaCanada
  4. 4.Division of Musculoskeletal Imaging Radiology, Department of Radiology, Faculty of MedicineUniversity of OttawaOttawaCanada
  5. 5.Imaging at Olympic ParkMelbourneAustralia

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