Skip to main content

Endplate changes after lumbar discectomy with and without implantation of an annular closure device

Acta Neurochirurgica volume 160, pages 855–862 (2018)Cite this article

Abstract

Background

The implantation of a bone-anchored annular closure device (ACD) might be associated with the developed new endplate changes (EPC) after surgery.

Methods

A post hoc analysis has been done in patients from a prospective randomized multicenter study. All patients underwent limited lumbar discectomy with intraoperative randomization into the groups limited lumbar discectomy alone or additional ACD implantation. Low-dose lumbar computed tomography (CT) and clinical investigations were performed preoperatively and 12 months after the operation.

Results

A total of 554 patients were randomized. After exclusion of dropouts, the per-protocol population included 493 patients (251 in the control group and 242 in the ACD group); the follow-up rate was ≥ 90%. The number of patients showing EPC at baseline was similar in both groups. The number of patients showing EPC and the total EPC lesion area significantly increased in both groups over time, but significantly increased more in the EPC group for the superior and inferior endplate (all P < 0.0001). There was no association of pre-existing number and size of EPC with sex, age, or smoking habits. Correlation of clinical variables showed no relation with number, size, and increase of EPC area after surgery.

Conclusions

Patients with primary lumbar disc herniation show EPC in the corresponding segments. There is a significant increase of lesion number and size within 12 months after discectomy. This increase is significantly more pronounced in the ACD group. Presence and growth of EPC is not correlated with low-back pain or ODI.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3

References

  1. Antonacci MD, Mody DR, Rutz K, Weilbaecher D, Heggeness MH (2002) A histologic study of fractured human vertebral bodies. J Spinal Disord Tech 15:118–126

    Article  PubMed  Google Scholar 

  2. Barth M, Fontana J, Thome C, Bouma GJ, Schmieder K (2016) Occurrence of discal and non-discal changes after sequestrectomy alone versus sequestrectomy and implantation of an annulus closure device. J Clin Neurosci 34:288–293

    Article  PubMed  Google Scholar 

  3. Bouma GJ, Barth M, Ledic D, Vilendecic M (2013) The high-risk discectomy patient: prevention of reherniation in patients with large annular defects using an annular closure device. Eur Spine J 22:1030–1036

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dar G, Peleg S, Masharawi Y, Steinberg N, May H, Hershkovitz I (2009) Demographical aspects of Schmorl nodes: a skeletal study. Spine (Phila Pa 1976) 34:E312–E315

    Article  Google Scholar 

  5. Klassen P, Hes R, Bouma GJ, Eustacchio S, Barth M, Kursumovic A, Jadik S, Heidecke V, Bostelmann R, Thome C, Vaikoczy P, Köhler HP, Fandino J, Assaker R, Van de Kelft E, Fröhlich S, Van den Brink W, Perrin J, Wolfs J, Arts M, Martens F (2016) A multicenter, prospective, randomized study protocol to demonstrate the superiority of a bone-anchored prosthesis for annular closure used in conjunction with limited discectomy to limited discectomy alone for primary lumbar disc herniation. Int J Clin Trials 3:120–131

    Article  Google Scholar 

  6. Lotz JC, Fields AJ, Liebenberg EC (2013) The role of the vertebral end plate in low back pain. Global Spine J 3:153–164

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Mach DB, Rogers SD, Sabino MC, Luger NM, Schwei MJ, Pomonis JD, Keyser CP, Clohisy DR, Adams DJ, O’Leary P, Mantyh PW (2002) Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience 113:155–166

    CAS  Article  PubMed  Google Scholar 

  8. 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 (Phila Pa 1976) 35:1944–1952

    Article  Google Scholar 

  9. Newell N, Grant CA, Izatt MT, Little JP, Pearcy MJ, Adam CJ (2015) A semiautomatic method to identify vertebral end plate lesions (Schmorl’s nodes). Spine J 15:1665–1673

    Article  PubMed  Google Scholar 

  10. Oetgen ME, Yue JJ, la Torre JJ, 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 2:101–106

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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 219:368–374

    CAS  Article  PubMed  Google Scholar 

  12. van Dieen JH, Weinans H, Toussaint HM (1999) Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in a specific low back pain. Med Hypotheses 53:246–252

    Article  PubMed  Google Scholar 

  13. Wang Y, Videman T, Battie MC (2012) Lumbar vertebral endplate lesions: prevalence, classification, and association with age. Spine (Phila Pa 1976) 37:1432–1439

    Article  Google Scholar 

  14. Wang Y, Videman T, Battie MC (2013) Morphometrics and lesions of vertebral end plates are associated with lumbar disc degeneration: evidence from cadaveric spines. J Bone Joint Surg Am 95:e26

    Article  PubMed  Google Scholar 

  15. Weiner BK, Vilendecic M, Ledic D, Eustacchio S, Varga P, Gorensek M, Fernandez-Moure J, Hipp JA (2015) Endplate changes following discectomy: natural history and associations between imaging and clinical data. Eur Spine J 24:2449–2457

    Article  PubMed  Google Scholar 

Download references

Funding

Intrinsic Therapeutics, Inc. provided financial support in the form of analysis of all images at an independent institution (Intrinsic Imaging LLC, Bolton, Massachusetts, USA). The sponsor had no role in analysis and interpretation of the data.

Author information

Affiliations

  1. Department of Neurosurgery, Knappschafts-Krankenhaus Bochum, Ruhr-University Bochum, In der Schornau 23-25, 44892, Bochum, Germany

    Martin Barth

  2. Department of Medical Statistics, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany

    Christel Weiß

  3. Department of Neurosurgery, OLVG, Academic Medical Center, Amsterdam, Netherlands

    Gerrit J. Bouma

  4. Department of Neurosurgery, Heinrich Heine University, Duesseldorf, Germany

    Richard Bostelmann

  5. Department of Neurosurgery, DONAUISAR Klinikum, Deggendorf, Germany

    Adisa Kursumovic

  6. Department of Neurosurgery, Kantonsspital Aarau, Aarau, Switzerland

    Javier Fandino

  7. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

    Claudius Thomé

Authors
  1. Martin Barth
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christel Weiß
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gerrit J. Bouma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard Bostelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adisa Kursumovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Javier Fandino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Claudius Thomé
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Martin Barth.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the corresponding institutional research committees (multicenter study) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Barth, M., Weiß, C., Bouma, G.J. et al. Endplate changes after lumbar discectomy with and without implantation of an annular closure device. Acta Neurochir 160, 855–862 (2018). https://doi.org/10.1007/s00701-017-3463-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3463-y

Keywords

  • Annular closure device
  • Lumbar discectomy
  • Outcome