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The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal study

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Abstract

Purpose

To investigate the influence of vertebral endplate defects and subchondral bone marrow changes on the development of lumbar intervertebral disc degeneration (DD).

Methods

Patients > 18 y/o without any history of lumbar fusion who had repeat lumbar magnetic resonance imaging scans primarily for low back pain (LBP) performed at a minimum of 3 years apart at a single institution, and no spinal surgery in between scans were included. Total endplate score (TEPS), Modic changes (MC), and Pfirrmann grading (PFG) per lumbar disc level were assessed. DD was defined as PFG ≥ 4.

Results

Three hundred and fifty-three patients (54.4% female) were included in the final analysis, comprising 1765 lumbar intervertebral discs. The patient population was 85.6% Caucasian with a median age of 60.1 years and a body mass index (BMI) of 25.8 kg/m2. A cutoff score of 5 was identified for the TEPS above which both the prevalence of DD and the odds of developing DD increased. The probability of developing DD did not differ significantly between lumbar disc levels (P = 0.419). In the multivariable analysis with adjustments for age, sex, race, body mass index (BMI), MC, TEPS cutoff > 5, and spinal level, only age (OR = 1.020; P = 0.002) was found to be an independent risk factor for developing intervertebral DD.

Conclusion

Our results suggest that TEPS does not unequivocally predict intervertebral DD in patients with LBP, since higher degrees of endplate defects might also develop secondarily to DD, and MC tend to occur late in the cascade of degeneration.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

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Authors and Affiliations

  1. Spine Care Institute, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA

    Manuel Moser, Dominik Adl Amini, Leonardo Albertini Sanchez, Lisa Oezel, Henryk Haffer, Maximilian Muellner, Jiaqi Zhu, Jennifer Shue, Andrew A. Sama, Frank P. Cammisa, Federico P. Girardi & Alexander P. Hughes

  2. Department of Spine Surgery, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland

    Manuel Moser

  3. Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany

    Dominik Adl Amini, Henryk Haffer & Maximilian Muellner

  4. Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, USA

    Leonardo Albertini Sanchez

  5. Department of Orthopedic Surgery and Traumatology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany

    Lisa Oezel

  6. Department of Radiology and Imaging, Hospital for Special Surgery, Weill Cornell Medicine, 535 East 70th Street, New York, NY, 10021, USA

    John A. Carrino

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Contributions

MM, JAC, JS, AAS, FPC, FPG, and APH contributed to conception and design. MM, DAA, LAS, LO, HH, and MM contributed to acquisition of data. MM, JZ, and APH contributed to analysis and interpretation of data. MM contributed to drafting the article. All authors critically revising the article. All authors reviewed submitted version of manuscript. APH approved the final version of the manuscript on behalf of all authors. MM and JZ contributed to statistical analysis. JS contributed to administrative/technical/material support. APH contributed to study supervision.

Corresponding author

Correspondence to Alexander P. Hughes.

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Conflict of interests

Authors DAA, LAS, LO, HH, MM, JZ, and JS have no relevant financial or non-financial interests to disclose. Author MM declares financial interests: Research Support: Medtronic (Schweiz) AG. Author JAC declares financial interests: Consulting: Pfizer, Inc.; Eli-Lilly; Globus Medical; Regeneron; AstraZeneca; Scientific Advisory Board: Carestream; Image Analysis Group; Image Biopsy Lab. Author AAS declares financial interests: Royalties: Ortho Development Corp. Private Investments: Vestia Ventures MiRus Investment, LLC; ISPH II, LLC; ISPH 3, LLC; VBros Venture Partners X; Centinel Spine. Consulting: Clariance, Inc.; Kuros Biosciences AG, DePuy Synthes Products, Inc./Medical Device Business Services, Inc. Speaking and/or Teaching Arrangements: DePuy Synthes Products, Inc./Medical Device Business Services, Inc. Scientific Advisory Board: DePuy Synthes Products, Inc./Medical Device Business Services, Inc. Research Support: Spinal Kinetics, Inc. Author FPC declares financial interests: Research Support: 4WEB Medical Inc.; Camber Spine, Centinel Spine; Mallinckrodt Pharmaceuticals. Consulting: Accelus, NuVasive, Inc.; Spine Biopharma, LLC. Royalties: Accelus. Ownership Interest: Healthpoint Capital Partners, LP; ISPH II, LLC; ISPH 3 Holdings, LLC; Ivy Healthcare Capital Partners, LLC; Medical Device Partners II, LLC; Medical Device Partners III, LLC; Tissue Differentiation Intelligence, LLC; VBVP VI, LLC; VBVP X, LLC; Woven Orthopedic Technologies. Board of Directors: Orthobond Corporation; Medical Device Partners II, LLC; Spine Biopharma, LLC; Woven Orthopedic Technologies. Author FPG declares financial interests: Consulting: DePuy Synthes Spine; NuVasive, Inc.; Spineart USA, Inc.; Ethicon, Inc.; Ortho Development Corp. Stock/Shareholder: Bonovo Orthopedics, Inc.; Healthpoint Capital Partners, LP; Tissue Differentiation Intelligence; BICMD. Royalties: NuVasive, Inc.; Ortho Development Corp; DePuy Synthes Spine. Author APH declares financial interests: Research Support: Kuros Biosciences AG. Fellowship Support: Kuros Biosurgery AG, NuVasive, Inc.

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IRB approval: Hospital for Special Surgery #2019–2137.

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Moser, M., Adl Amini, D., Albertini Sanchez, L. et al. The association between vertebral endplate defects, subchondral bone marrow changes, and lumbar intervertebral disc degeneration: a retrospective, 3-year longitudinal study. Eur Spine J 32, 2350–2357 (2023). https://doi.org/10.1007/s00586-023-07544-4

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