Lumbar vertebral endplate defects on magnetic resonance images: prevalence, distribution patterns, and associations with back pain

Abstract

BACKGROUND CONTEXTAlthough the roles of Modic Changes (MCs) and disc degeneration in back pain remain controversial, clues from cadaveric studies suggest that lumbar vertebral endplate lesions may be important in back pain. Endplate lesions can be detected on magnetic resonance (MR) images as various endplate defects, including focal, corner, and erosive defects. Yet, the clinical significance of such endplate defects remains unknown. PURPOSETo determine the prevalence and distribution patterns of lumbar vertebral endplate defects and their associations with back pain in a population-based sample. STUDY DESIGNCross-sectional study. PATIENT SAMPLESubjects were randomly selected from a typical community in Hangzhou Eastern China, regardless of back pain status. OUTCOME MEASURESEach subject underwent a structured interview and lumbar MR imaging. Back pain history, including today, over the past 4 weeks, 12 months, and lifetime, were acquired. Endplate defects, MCs, and disc degeneration were evaluated on MRIs. Age, gender and body mass index (kg/m2), as well as lifetime exposures, including smoking history, riding in motorized vehicles and associated vibration, and occupational physical demands were assessed. METHODSDescriptive statistics were used to depict prevalence and distribution patterns of endplate defects in the lumbar spine. Logistic regressions were used to examine associations of endplate defects with back pain. The research grant was obtained from the National Natural Science Foundation of China (115,000 USD), Key Platform Project of the Health Department of Zhejiang Province (14,000 USD), Technology Program of Traditional Chinese Medicine Department of Zhejiang Province (21,000 USD), and 2015 Qianjiang Talent Program of Zhejiang Province (7,000 USD) toward this work. There is no conflict to disclose. RESULTSThere were 478 subjects (53.3±14.4 years, range 20–88 years) studied. Endplate defects presented in 301 (63.0%) subjects and 842 (16.0%) endplates. The presence of endplate defects, but not MCs and disc degeneration, was associated with lifetime back pain (odds ratio=1.64, p=.026) in multivariate analyses. Focal and erosive endplate defects were associated with lifetime back pain history (odds ratio=1.74–2.23, p<.05 for both), whereas all three types of defects were associated with intensity of worst back pain over the past 12 months (Coef=5.84–7.19, p<.05 for all). CONCLUSIONSEndplate defects are common findings on lumbar MRIs in adults. Specific types of endplate defects were associated with back pain history. Endplate defects may be an independent risk factor for back pain.