Skip to main content
SpringerLink
Log in

The intervertebral disc, the endplates and the vertebral bone marrow as a unit in the process of degeneration

  • Musculoskeletal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The association of disc degeneration (DD) and vertebral endplate degeneration (EPD) is still not well understood. This study aimed to find segmental predictive risk factors for DD and EPD and to illuminate associations of the disc, endplate and bone marrow changes in the process of degeneration.

Methods

After institutional review board approval, 450 lumbar levels, followed up with MRI for at least 4 years, were retrospectively graded for DD according to Pfirrmann (PFG), for EPD according to the endplate score (EPS) and according to the presence, extension and type of Modic changes (MC). Clustered logistic regression and multivariate analysis was applied in nested, matched case-control subgroups to evaluate potential local risk factors for progression.

Results

An EPS score of  ≥4 was identified as an independent risk factor for progression of DD (OR = 2.32, 95%CI:1.07–5.01,p = 0.03) and MC (OR = 5.49,95%CI:2.30–13.10,p < 0.001). Progression of DD was significantly accompanied by progression or evolution of MC (OR = 12.25,95%CI:1.49–100.6,p = 0.02) and with progression of EPS (OR = 1.71, 95%CI:1.00–1.05, p = 0.01). Once advanced DD has occurred, it becomes a risk factor for progression in EPS (OR = 2.24,95%CI:1.23–4.12,p < 0.01).

Conclusions

The degenerative processes in the disc, endplate and bone marrow are highly associated. An EPS ≥ 4 is an independent risk factor for DD and MC progression in a population with low back pain.

Key Points

• The degenerative processes in the disc, endplate and bone marrow are associated.

• An endplate score ≥4 is a risk factor for DD and MC progression.

• Modic changes are last to occur in the development of segmental intervertebral degeneration.

• A new segmental grading system is suggested.

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
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

  1. Battié MC, Videman T, Kaprio J et al (2009) The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J 47–59

  2. Matsui H, Kanamori M, Ishihara H, Yudoh K, Naruse Y, Tsuji H (1998) Familial predisposition for lumbar degenerative disc disease. A case-control study. Spine (Phila Pa 1976) 23:1029–1034

    Article  CAS  Google Scholar 

  3. Miller JA, Schmatz C, Schultz AB (1988) Lumbar disc degeneration: correlation with age, sex, and spine level in 600 autopsy specimens. Spine (Phila Pa 1976) 173–178

  4. Videman T, Sarna S, Battié MC et al (1995) The long-term effects of physical loading and exercise lifestyles on back-related symptoms, disability, and spinal pathology among men. Spine (Phila Pa 1976) 699–709

  5. Mundt DJ, Kelsey JL, Golden AL et al (1993) An epidemiologic study of non-occupational lifting as a risk factor for herniated lumbar intervertebral disc. The Northeast Collaborative Group on Low Back Pain. Spine (Phila Pa 1976) 18:595–602

    Article  CAS  Google Scholar 

  6. Battié MC, Videman T, Gill K et al (1991) 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine (Phila Pa 1976) 1015–1021

  7. Kauppila LI (2009) Atherosclerosis and disc degeneration/low-back pain--a systematic review. Eur J Vasc Endovasc Surg 661–670

  8. Boden SD, Davis DO, Dina TS, Patronas NJ, Wiesel SW (1990) Abnormal magnetic-resonance scans of the lumbar spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am 403–408

  9. Powell MC, Wilson M, Szypryt P, Symonds EM, Worthington BS (1986) Prevalence of lumbar disc degeneration observed by magnetic resonance in symptomless women. Lancet 1366–1367

  10. Wiesel SW, Tsourmas N, Feffer HL, Citrin CM, Patronas N (1984) A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine (Phila Pa 1976) 549–551

  11. Nadja AF-A, Alexander PH, Alexander A, Richard JH, Mazda F, (2014) Determinants of evolution of endplate and disc degeneration in the lumbar spine: a multifactorial perspective. European Spine Journal 23(9):1863–1868

  12. Gallucci M, Puglielli E, Splendiani A, Pistoia F, Spacca G (2005) Degenerative disorders of the spine. Eur Radiol 15:591–598

    Article  PubMed  Google Scholar 

  13. Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 1873–1878

  14. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 193–199

  15. Rajasekaran S, Venkatadass K, Naresh Babu J, Ganesh K, Shetty AP (2008) Pharmacological enhancement of disc diffusion and differentiation of healthy, ageing and degenerated discs : results from in-vivo serial post-contrast MRI studies in 365 human lumbar discs. Eur Spine J 626–643

  16. Moon SM, Yoder JH, Wright AC, Smith LJ, Vresilovic EJ, Elliott DM (2013) Evaluation of intervertebral disc cartilaginous endplate structure using magnetic resonance imaging. Eur Spine J 22:1820–1828

    Article  PubMed  PubMed Central  Google Scholar 

  17. Albert HB, Briggs AM, Kent P, Byrhagen A, Hansen C, Kjaergaard K (2011) The prevalence of MRI-defined spinal pathoanatomies and their association with modic changes in individuals seeking care for low back pain. Eur Spine J 1355–1362

  18. Farshad-Amacker NA, Hughes AP, Aichmair A, Herzog RJ, Farshad M (2014) Is an annular tear a predictor for accelerated disc degeneration? Eur Spine J. doi:10.1007/s00586-014-3260-8

    Google Scholar 

  19. Vital JM, Gille O, Pointillart V et al (2003) Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine (Phila Pa 1976) 715–720- discussion 721

  20. Hutton MJ, Bayer JH, Powell JM (2011) Modic vertebral body changes: the natural history as assessed by consecutive magnetic resonance imaging. Spine (Phila Pa 1976) 2304–2307

  21. Kuisma M, Karppinen J, Niinimäki J et al (2006) A three-year follow-up of lumbar spine endplate (Modic) changes. Spine (Phila Pa 1976) 1714–1718

  22. Fardon DF, Milette PC, Combined Task Forces of the North American Spine Society ASoSR, and American Society of Neuroradiology (2001) Nomenclature and classification of lumbar disc pathology. Recommendations of the Combined task Forces of the North American Spine Society, American Society of Spine Radiology, and American Society of Neuroradiology. Spine (Phila Pa 1976) E93–E113

  23. Modic MT, Steinberg PM, Ross JS, Masaryk TJ, Carter JR (1988) Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology 166:193–199

    Article  CAS  PubMed  Google Scholar 

  24. Albert HB, Manniche C (2007) Modic changes following lumbar disc herniation. Eur Spine J 16:977–982

    Article  PubMed  PubMed Central  Google Scholar 

  25. de Roos A, Kressel H, Spritzer C, Dalinka M (1987) MR imaging of marrow changes adjacent to end plates in degenerative lumbar disk disease. AJR Am J Roentgenol 149:531–534

    Article  PubMed  Google Scholar 

  26. Tanaka M, Nakahara S, Inoue H (1993) A pathologic study of discs in the elderly. Separation between the cartilaginous endplate and the vertebral body. Spine (Phila Pa 1976) 18:1456–1462

    Article  CAS  Google Scholar 

  27. Friberg S, Hirsch C (1949) Anatomical and clinical studies on lumbar disc degeneration. Acta Orthop Scand 19:222–242

    Article  CAS  PubMed  Google Scholar 

  28. 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 368–374

  29. Frobin W, Brinckmann P, Kramer M, Hartwig E (2001) Height of lumbar discs measured from radiographs compared with degeneration and height classified from MR images. Eur Radiol 11:263–269

    Article  CAS  PubMed  Google Scholar 

  30. Fetto JF, Marshall JL (1979) Injury to the anterior cruciate ligament producing the pivot-shift sign. J Bone Joint Surg Am 61:710–714

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Mazda Farshad. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

This study has received funding by: Grant Support: Department fund of the MRI Department, Hospital for Special Surgery, USA and individual funding of Swiss National Foundation (N.F. PBZHP3_143674). Burkhardt Seifert kindly provided statistical advice for this manuscript. Institutional review board approval was obtained.

Written informed consent was waived by the Institutional Review Board.

Some study subjects or cohorts have been previously reported in:

1. Farshad-Amacker NA, Hughes AP, Aichmair A, Herzog RJ, Farshad M. Determinants of evolution of endplate and disc degeneration in the lumbar spine: a multifactorial perspective. European Spine Journal. 2014 Jun 5.

2. Farshad-Amacker NA, Hughes AP, Aichmair A, Herzog RJ, Farshad M. Is an annular tear a predictor for accelerated disc degeneration? European Spine Journal. 2014 Mar 13.

Methodology: retrospective, case-control study, performed at one institution.

Author information

Authors and Affiliations

  1. MRI, Radiology Department, Hospital for Special Surgery, New York, NY, USA

    Nadja A. Farshad-Amacker

  2. Institute of Diagnostic and Interventional Radiology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland

    Nadja A. Farshad-Amacker

  3. Spine Surgery, Hospital for Special Surgery, New York, NY, USA

    Alexander Hughes

  4. Spinal Imaging, Hospital for Special Surgery, New York, NY, USA

    Richard J. Herzog

  5. Departement of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland

    Burkhardt Seifert

  6. Spine Division, Balgrist University Hospital, Forchstrasse 340, Zurich, 8008, Switzerland

    Mazda Farshad

Authors
  1. Nadja A. Farshad-Amacker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Richard J. Herzog
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Burkhardt Seifert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mazda Farshad
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nadja A. Farshad-Amacker.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Farshad-Amacker, N.A., Hughes, A., Herzog, R.J. et al. The intervertebral disc, the endplates and the vertebral bone marrow as a unit in the process of degeneration. Eur Radiol 27, 2507–2520 (2017). https://doi.org/10.1007/s00330-016-4584-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-016-4584-z

Keywords

Search

Navigation