Abstract
BackgroundVertebral endplate signal changes (VESC) are more common among patients with low back pain (LBP) and/or sciatica than in people who are not seeking care for back pain. The distribution and characteristics of VESC have been described in people from clinical and non-clinical populations. However, while the clinical course of VESC has been studied in patients, the natural course in the general population has not been reported. The objectives of this prospective observational study were to describe: 1) the distribution and characteristics of VESC in the lumbar spine, 2) its association with disc degeneration, and 3) its natural course from 40 to 44 years of age.MethodsThree-hundred-and-forty-four individuals (161 men and 183 women) sampled from the Danish general population had MRI at the age of 40 and again at the age of 44. The following MRI findings were evaluated using standardised evaluation protocols: type, location, and size of VESC, disc signal, and disc height. Characteristics and distribution of VESC were analysed by frequency tables. The association between VESC and disc degeneration was analysed by logistic regression analysis. The change in type and size of VESC was analysed by cross-tabulations of variables obtained at age 40 and 44 and tested using McNemar's test of symmetry.ResultsTwo-thirds (67%) of VESC found in this study were located in the lower part of the spine (L4-S1). VESC located at disc levels L1-L3 were generally small and located only in the anterior part of the vertebra, whereas those located at disc levels L4-S1 were more likely to extend further into the vertebra and along the endplate. Moreover, the more the VESC extended into the vertebra, the more likely it was that the adjacent disc was degenerated. The prevalence of endplate levels with VESC increased significantly from 6% to 9% from age 40 to 44. Again, VESC that was only observed in the endplate was more likely to come and go over the four-year period compared with those which extended further into the vertebra, where it generally persisted.ConclusionThe prevalence of VESC increased significantly over the four-year period. Furthermore, the results from this study indicate that the distribution of VESC, its association with disc degeneration and its natural course, is dependent on the size of the signal changes.
Highlights
Vertebral endplate signal changes (VESC) are more common among patients with low back pain (LBP) and/or sciatica than in people who are not seeking care for back pain
In a recent systematic literature review, the prevalence of VESC was found to increase with age and to be lower in nonclinical populations than in clinical populations, with median prevalence rates of 6% and 43% respectively
The results from this study show that: 1) the prevalence of VESC increases from the age of 40 to the age of 44 and 2) the distribution over vertebral levels, presence of disc degeneration and the natural course of VESC is dependent on the size of the signal changes
Summary
Vertebral endplate signal changes (VESC) are more common among patients with low back pain (LBP) and/or sciatica than in people who are not seeking care for back pain. While the clinical course of VESC has been studied in patients, the natural course in the general population has not been reported The objectives of this prospective observational study were to describe: 1) the distribution and characteristics of VESC in the lumbar spine, 2) its association with disc degeneration, and 3) its natural course from 40 to 44 years of age. In a descriptive study of VESC, Modic et al investigated 474 patients referred for lumbar Magnetic Resonance Imaging (MRI)[4]. They described two types of signal changes: type 1 seen as hypointensity on T1-weighted images and hyperintensity on T2, and type 2 seen as hyperintensity on T1 and T2-weighted images. Type 3 was described as hypointensity on T1 and T2-weighted images representing sclerosis as seen on radiographs[5]
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