Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and distribution of Schmorl node and endplate signal change, and correlation with disc degeneration in a population-based cohort: the Wakayama Spine Study

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

Degenerative spinal conditions, including disc degeneration (DD), Schmorl nodes (SN), and endplate signal changes (ESC), are pervasive age-associated phenomena that critically affect spinal health. Despite their prevalence, a comprehensive exploration of their distribution and correlations is lacking. This study examined the prevalence, distribution, and correlation of DD, SN, and ESC across the entire spine in a population-based cohort.

Methods

The Wakayama Spine Study included 975 participants (324 men, mean age 67.2 years; 651 women, mean age 66.0 years). Magnetic resonance imaging (MRI) was used to evaluate the intervertebral space from C2/3 to L5/S1. DD was classified using Pfirrmann's system, ESC was identified by diffuse high-intensity signal changes on the endplates, and SN was defined as a herniation pit with a hypointense signal. We assessed the prevalence and distribution of SN, ESC, and DD across the entire spine. The correlations among these factors were examined.

Results

Prevalence of ≥ 1 SN over the entire spine was 71% in men and 77% in women, while prevalence of ≥ 1 ESC was 57.9% in men and 56.3% in women. The prevalence of ESC and SN in the thoracic region was the highest among the three regions in both sexes. Positive linear correlations were observed between the number of SN and DD (r = 0.41, p < 0.001) and the number of ESC and DD (r = 0.40, p < 0.001), but weak correlations were found between the number of SN and ESC (r = 0.29, p < 0.001).

Conclusion

The prevalence and distribution of SN and ESC over the entire spine were observed, and correlations between SN, ESC, and DD were established. This population-based cohort study provides a comprehensive analysis of these factors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Code availability

Not applicable   .

References

  1. Lurie JD, Doman DM, Spratt KF, Tosteson ANA, Weinstein JN (2009) Magnetic resonance imaging interpretation in patients with symptomatic lumbar spine disc herniations. Comparison of clinician and radiologist readings. Spine 34:701–705

    Article  PubMed  PubMed Central  Google Scholar 

  2. Teraguchi M, Yoshimura N, Hashizume H, Muraki S, Yamada H, Oka H et al (2015) The association of combination of disc degeneration, end plate signal change, and Schmorl node with low back pain in a large population study: the Wakayama spine study. Spine J 15(4):622–628

    Article  PubMed  Google Scholar 

  3. Modic MT, Steinberg PM, Ross JS et al (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199

    Article  CAS  PubMed  Google Scholar 

  4. Modic MT, Masaryk TJ, Ross JS et al (1988) Imaging of degenerative disk disease. Radiology 168:177–186

    Article  CAS  PubMed  Google Scholar 

  5. Teraguchi M, Hashizume H, Oka H et al (2022) Detailed subphenotyping of lumbar modic changes and their association with low back pain in a large population-based study: the Wakayama spine study. Pain Ther 11(1):57–71

    Article  PubMed  Google Scholar 

  6. Othman M, Menon VK (2022) The prevalence of Schmorl’s nodes in osteoporotic vs normal patients: a Middle Eastern population study. Osteoporos Int 33:1493–1499

    Article  CAS  PubMed  Google Scholar 

  7. Sonnen-Holm S, Jacobsen S, Rovising H et al (2013) The epidemiology of Schmorl’s nodes and their correlation to radiographic degeneration in 4151 subjects. Eur Spine J 22(8):1907–1912

    Article  Google Scholar 

  8. Pfirrmann C, Resnick D (2001) Schmorl nodes of the thoracic and lumbar spine: radiographic-pathologic study of prevalence, characterization, and correlation with degenerative changes of 1650 spinal levels in 100 cadavers. Radiology 219:368–374

    Article  CAS  PubMed  Google Scholar 

  9. Williams FM, Manek NJ, Sambrook PN et al (2007) Schmorl’s nodes: common, highly heritable, and related to lumbar disc disease. Arthritis Rheum 57:855–860

    Article  CAS  PubMed  Google Scholar 

  10. Yoshimura N, Muraki S, Oka H, Kawaguchi H, Nakamura K, Akune T (2010) Cohort profile: research on osteoarthritis/osteoporosis against disability (ROAD) study. Int J Epidemiol 39:988–995

    Article  PubMed  Google Scholar 

  11. Yoshimura N, Muraki S, Oka H, Mabuchi A, En-Yo Y, Yoshida M et al (2009) Prevalence of knee osteoarthritis, lumbar spondylosis, and osteoporosis in Japanese men and women: the research on osteoarthritis/osteoporosis against disability study. J Bone Miner Metab 27:620–628

    Article  PubMed  Google Scholar 

  12. Teraguchi M, Yoshimura N, Hashizume H et al (2014) Prevalence and distribution of intervertebral disc degeneration over the entire spine in a population-based cohort: the Wakayama spine study. Osteoarthr Cartil 22:104–110

    Article  CAS  Google Scholar 

  13. Teraguchi M, Yoshimura N, Hashizume H et al (2017) Progression, incidence, and risk factors for intervertebral disc degeneration in a longitudinal population-based cohort: the Wakayama spine study. Osteoarthr Cartil 25(7):1122–1131

    Article  CAS  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  15. Kuisma M, Karppinen J, Niinimaki J, Kurunlahti M et al (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine 31:1714–1718

    Article  PubMed  Google Scholar 

  16. Mok FP, Samartzis D, Karppinen J, Luk KD, Fong DY, Cheung KM (2010) ISSLS prize winner: prevalence, determinants, and association of Schmorl nodes of the lumbar spine with disc degeneration: a population-based study of 2449 individuals. Spine 35:1944–1952

    Article  PubMed  Google Scholar 

  17. Splendiani A, Bruno F, Marsecano C et al (2019) Modic I changes size increase from supine to standing MRI correlates with increase in pain intensity in standing position: Uncovering the “biomechanical stress” and “active discopathy” theories in low back pain. Eur Spine J 28(5):983–992

    Article  PubMed  Google Scholar 

  18. Peterson CK, Gatterman B, Carter JC, Humphreys BK et al (2007) Inter- and intraexaminer reliability in identifying and classifying degenerative marrow (Modic) changes on lumbar spine magnetic resonance scans. J Manip Physiol Ther 30:85–90

    Article  Google Scholar 

  19. Peterson CK, Humphreys BK, Pringle TC (2007) Prevalence of Modic degenerative marrow changes in the cervical spine. J Manipul Physiol Ther 30:5–10

    Article  Google Scholar 

  20. Keller T, Colloca CJ, Harrison DE, Harrison DD, Janik TJ (2005) Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: implications for the ideal spine. Spine J 5:297–309

    Article  PubMed  Google Scholar 

  21. Teraguchi M, Yoshimura N, Hashizume H, Muraki S, Yamada H, Oka H et al (2016) Metabolic syndrome components are associated with intervertebral disc degeneration: the Wakayama spine study. PLoS ONE 11(2):e0147565

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hamanishi C, Kawabata T, Yosii T, Tanaka S (1994) Schmorl’s nodes on magnetic resonance imaging: their incidence and clinical relevance. Spine 19:450–453

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Wan ZY, Zhang J, Shan H, Liu TF et al (2023) Epidemiology of lumbar degenerative phenotypes of children and adolescents: a large-scale imaging study. Global Spine J 13(3):599–608

    Article  PubMed  Google Scholar 

  25. Fahey V, Opeskin K, Silberstein M, Anderson R, Briggs C (1998) The pathogenesis of Schmorl’s nodes in relation to acute trauma:an autopsy study. Spine 23:2272–2275

    Article  CAS  PubMed  Google Scholar 

  26. Walters G, Coumas JM, Akins CM, Ragland RL (1991) Magnetic resonance imaging of acute symptomatic Schmorl’s node for-mation. Pediatr Emerg Care 7(5):294–296

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Mrs. Tamako Tsutsumi, Mrs. Kanami Maeda, and other members of the Public Office in Taiji Town for their assistance in locating and scheduling the participants for examinations. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Funding

This work was supported by H-25-Choujyu-007 (Director, NY), H25-Nanchitou (Men)-005 (Director, ST), and 201417014A (Director, NY) from the Ministry of Health, Labour and Welfare, a Grant-in-Aid for Scientifc Research (C 26861206) of JSPS KAKENHI grant. And Collaborating Research with NSF 08033011-00262 (Direc tor, NY) from the Ministry of Education, Culture, Sports, Science, and Technology in Japan. This study also was supported by grants from the Japan Osteoporosis Society (NY, HO), a grant from JA Kyosai Research Institute (HO), Japan Society for the Promotion of Science, Grants-in-Aid for Scientifc Research (KAKENHI) Research C (1 7 K 1 0 9 3 7) (MT), a Grant from the Japanese Orthopaedics and Traumatology Foundation, Inc (No. 287) (MT), The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama, Wakayama, Japan

    Masatoshi Teraguchi, Hiroshi Hashizume, Ryohei Kagotani, Keiji Nagata, Yuyu Ishimoto, Munehito Yoshida & Hiroshi Yamada

  2. Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Hiroyuki Oka

  3. Department of Orthopaedic Surgery, Sumiya Orthopaedic Hospital, Wakayama, Japan

    Munehito Yoshida

  4. Department of Orthopaedic Surgery, The University of Tokyo, Bunkyoku, Tokyo, Japan

    Sakae Tanaka

  5. Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan

    Noriko Yoshimura

Authors
  1. Masatoshi Teraguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroshi Hashizume
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroyuki Oka
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ryohei Kagotani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Keiji Nagata
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuyu Ishimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sakae Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Munehito Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Noriko Yoshimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroshi Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MT: Critical editing of the paper, interpretation of findings, administrative support, obtaining of funding, supervision of the study, conception of study design. HH: Critical editing of the paper, interpretation of findings. HO: Data collection, critical editing of the paper, interpretation of findings. RK: Data collection. KN: Critical editing of the paper. YI: Critical editing of the paper. ST: Critical editing of the paper. MY: Critical editing of the paper, supervision of the study, conception of study design. NY: Critical editing of the paper, supervision of the study, conception of study design. HY: Critical editing of the paper, supervision of the study, conception of study design.

Corresponding author

Correspondence to Masatoshi Teraguchi.

Ethics declarations

Conflict of Interest

There is no conflict of interests.

Ethical approval

The study was conducted with the approval of the ethics committee of our university and in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Consent to participate

All patients were required to provide written informed consent prior to participation.

Consent for publication

All author had consent for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Teraguchi, M., Hashizume, H., Oka, H. et al. Prevalence and distribution of Schmorl node and endplate signal change, and correlation with disc degeneration in a population-based cohort: the Wakayama Spine Study. Eur Spine J 33, 103–110 (2024). https://doi.org/10.1007/s00586-023-08009-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-023-08009-4

Keywords

Search

Navigation