The role of the vertebral end plate in low back pain

J C Lotz, A J Fields, E C Liebenberg, J C Lotz, A J Fields, E C Liebenberg

Abstract

End plates serve as the interface between rigid vertebral bodies and pliant intervertebral disks. Because the lumbar spine carries significant forces and disks don't have a dedicated blood supply, end plates must balance conflicting requirements of being strong to prevent vertebral fracture and porous to facilitate transport between disk cells and vertebral capillaries. Consequently, end plates are particularly susceptible to damage, which can increase communication between proinflammatory disk constituents and vascularized vertebral bone marrow. Damaged end plate regions can be sites of reactive bone marrow lesions that include proliferating nerves, which are susceptible to chemical sensitization and mechanical stimulation. Although several lines of evidence indicate that innervated end plate damage can be a source of chronic low back pain, its role in patients is likely underappreciated because innervated damage is poorly visualized with diagnostic imaging. This literature review summarizes end plate biophysical function and aspects of pathologic degeneration that can lead to vertebrogenic pain. Areas of future research are identified in the context of unmet clinical needs for patients with chronic low back pain.

Keywords: end plate; intervertebral disk; low back pain; spine.

Conflict of interest statement

Disclosures J. C. Lotz, Consultant, Research Support, Stock/Options: Relievant Medsystems, Nocimed LLC A. J. Fields, None E. C. Liebenberg, None

Figures

Fig. 1
Fig. 1
(A) Gross morphology of the lumbar intervertebral joint. (B) Histology section showing regions of interest for panels C, D, and E. (C) End plate detail showing cartilaginous and bony components with hematopoietic marrow elements. (D) Insertion of annular fibers into the end plate cartilage at the inner annulus junction. (E) Vascular sinusoids in the marrow space adjacent to the end plate. Note for panels A and B, left side is anterior.
Fig. 2
Fig. 2
Schematic representation of vertebral end plate development. (A) At embryonic week 6, the sclerotome begins to segment around the notochord to form periodic cartilaginous and fibrocartilaginous precursors to the vertebra and disks, respectively. (B) By embryonic week 15, the notochord atrophies within the vertebra, and ossification begins at the vertebral centers. (C) At embryonic week 25, the ossification centers expand as the vertebrae lengthen. Columnar cartilage develops at the vertebral ends to form the epiphyseal plates. (D) By age 5 years, the ossified portions of the vertebra extend to the lateral margins and the epiphyseal cartilage begins to thin. (E) By age 13 years, peripheral ossification centers outside the epiphyseal plate form the ring apophysis. (F) By age 18 years, the ring apophysis begins to fuse to the osseous mass of the vertebral body.
Fig. 3
Fig. 3
Distribution of protein gene product 9.5 (PGP 9.5)-positive nerve fibers across the end plates (63-year-old woman, L5-S1). Compared with the density of nerves in normal end plate regions, nerve density is higher in end plate regions with damage. Nerve fibers in this disk were observed in the inferoposterior outer annulus. Note: left side is anterior.
Fig. 4
Fig. 4
Midsagittal T1-weighted (A) and T2-weighted (B) magnetic resonance (MR) images of an L1-L2 motion segment with poor end plate signal. (C) Corresponding ultrashort time-to-echo (UTE) MR image showing enhanced end plate signal. Arrows indicate end plate defects shown in Fig. 5A and 5B. (UTE imaging courtesy of Drs. Roland Krug and Misung Han, Department of Radiology, University of California, San Francisco.)
Fig. 5
Fig. 5
Various end plate defects with hypothesized etiologies. (A) End plate cartilage avulsion resulting from bending motion that causes traction at the interface between the end plate and inner annulus. (B) Traumatic node with end plate fragment resulting from excessive compression with a healthy, gel-like nucleus pulposus. (C) Central end plate fracture with exposed trabeculae resulting from excessive compression with a degenerate, fibrous nucleus pulposus.
Fig. 6
Fig. 6
Prevalence of end plate pathologies in different regions may arise from distinct biomechanical conditions. (A) In the lower lumbar spine, the prevalence of end plate cartilage avulsions and erosions increases caudally, mirroring the increase in range of motion (combined flexion/extension data are shown). (B) In the upper lumbar spine, Schmorl nodes increase cranially, mirroring the decrease in trabecular bone mineral density and end plate strength.

References

    1. Freburger J K, Holmes G M, Agans R P. et al.The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169:251–258.
    1. Fagan A, Moore R, Vernon Roberts B, Blumbergs P, Fraser R. ISSLS prize winner: The innervation of the intervertebral disc: a quantitative analysis. Spine. 2003;28:2570–2576.
    1. van Dieën J H, Weinans H, Toussaint H M. Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in aspecific low back pain. Med Hypotheses. 1999;53:246–252.
    1. Roberts S, Menage J, Duance V, Wotton S, Ayad S. 1991 Volvo Award in basic sciences. Collagen types around the cells of the intervertebral disc and cartilage end plate: an immunolocalization study. Spine. 1991;16:1030–1038.
    1. Lotz J C. Animal models of intervertebral disc degeneration: lessons learned. Spine. 2004;29:2742–2750.
    1. Moore R J. The vertebral end-plate: what do we know? Eur Spine J. 2000;9:92–96.
    1. Dias M S. Normal and abnormal development of the spine. Neurosurg Clin N Am. 2007;18:415–429.
    1. Bick E M Copel J W Longitudinal growth of the human vertebra; a contribution to human osteogeny J Bone Joint Surg Am 195032(A:04)803–814.
    1. Bick E M, Copel J W. The ring apophysis of the human vertebra; contribution to human osteogeny. II. J Bone Joint Surg Am. 1951;33-A:783–787.
    1. Aspden R M, Hickey D S, Hukins D W. Determination of collagen fibril orientation in the cartilage of vertebral end plate. Connect Tissue Res. 1981;9:83–87.
    1. Antoniou J, Goudsouzian N M, Heathfield T F. et al.The human lumbar endplate. Evidence of changes in biosynthesis and denaturation of the extracellular matrix with growth, maturation, aging, and degeneration. Spine. 1996;21:1153–1161.
    1. Rodriguez A G, Slichter C K, Acosta F L. et al.Human disc nucleus properties and vertebral endplate permeability. Spine. 2011;36:512–520.
    1. Roberts S, Menage J, Urban J P. Biochemical and structural properties of the cartilage end-plate and its relation to the intervertebral disc. Spine. 1989;14:166–174.
    1. Wade K R, Robertson P A, Broom N D. A fresh look at the nucleus-endplate region: new evidence for significant structural integration. Eur Spine J. 2011;20:1225–1232.
    1. Fields A J, Sahli F, Rodriguez A G, Lotz J C. Seeing double: a comparison of microstructure, biomechanical function, and adjacent disc health between double- and single-layer vertebral endplates. Spine. 2012;37:E1310–E1317.
    1. Edwards W T, Zheng Y, Ferrara L A, Yuan H A. Structural features and thickness of the vertebral cortex in the thoracolumbar spine. Spine. 2001;26:218–225.
    1. Silva M J, Wang C, Keaveny T M, Hayes W C. Direct and computed tomography thickness measurements of the human, lumbar vertebral shell and endplate. Bone. 1994;15:409–414.
    1. Zhao F D, Pollintine P, Hole B D, Adams M A, Dolan P. Vertebral fractures usually affect the cranial endplate because it is thinner and supported by less-dense trabecular bone. Bone. 2009;44:372–379.
    1. Rodriguez A G, Rodriguez-Soto A E, Burghardt A J. et al.Morphology of the human vertebral endplate. J Orthop Res. 2012;30:280–287.
    1. Wang Y, Battié M C, Boyd S K, Videman T. The osseous endplates in lumbar vertebrae: thickness, bone mineral density and their associations with age and disk degeneration. Bone. 2011;48:804–809.
    1. Bailey J F, Liebenberg E, Degmetich S, Lotz J C. Innervation patterns of PGP 9.5-positive nerve fibers within the human lumbar vertebra. J Anat. 2011;218:263–270.
    1. Crock H V, Yoshizawa H. The blood supply of the lumbar vertebral column. Clin Orthop Relat Res. 1976;(115):6–21.
    1. Laroche M. Intraosseous circulation from physiology to disease. Joint Bone Spine. 2002;69:262–269.
    1. Montazel J L, Divine M, Lepage E, Kobeiter H, Breil S, Rahmouni A. Normal spinal bone marrow in adults: dynamic gadolinium-enhanced MR imaging. Radiology. 2003;229:703–709.
    1. Kricun M E. Red-yellow marrow conversion: its effect on the location of some solitary bone lesions. Skeletal Radiol. 1985;14:10–19.
    1. Meunier P, Aaron J, Edouard C, Vignon G. Osteoporosis and the replacement of cell populations of the marrow by adipose tissue. A quantitative study of 84 iliac bone biopsies. Clin Orthop Relat Res. 1971;(80):147–154.
    1. Crock H V, Goldwasser M, Yoshizawa H. Boca Raton, FL: CRC Press; 1988. Vascular anatomy related to the intervertebral disc.
    1. Lips P, van Ginkel F C, Netelenbos J C. Bone marrow and bone remodeling. Bone. 1985;6:343–344.
    1. Schnitzler C M, Mesquita J. Bone marrow composition and bone microarchitecture and turnover in blacks and whites. J Bone Miner Res. 1998;13:1300–1307.
    1. Burkhardt R, Kettner G, Böhm W. et al.Changes in trabecular bone, hematopoiesis and bone marrow vessels in aplastic anemia, primary osteoporosis, and old age: a comparative histomorphometric study. Bone. 1987;8:157–164.
    1. Tornvig L, Mosekilde L I, Justesen J, Falk E, Kassem M. Troglitazone treatment increases bone marrow adipose tissue volume but does not affect trabecular bone volume in mice. Calcif Tissue Int. 2001;69:46–50.
    1. Trudel G, Payne M, Mädler B. et al.Bone marrow fat accumulation after 60 days of bed rest persisted 1 year after activities were resumed along with hemopoietic stimulation: the Women International Space Simulation for Exploration study. J Appl Physiol. 2009;107:540–548.
    1. Sherman M S. The nerves of bone. J Bone Joint Surg Am . 1963;45:522–528.
    1. Antonacci M D, Mody D R, Heggeness M H. Innervation of the human vertebral body: a histologic study. J Spinal Disord. 1998;11:526–531.
    1. Bogduk N, Tynan W, Wilson A S. The nerve supply to the human lumbar intervertebral discs. J Anat. 1981;132(Pt 1):39–56.
    1. Mach D B, Rogers S D, Sabino M C. et al.Origins of skeletal pain: sensory and sympathetic innervation of the mouse femur. Neuroscience. 2002;113:155–166.
    1. Antonacci M D, Mody D R, Rutz K, Weilbaecher D, Heggeness M H. A histologic study of fractured human vertebral bodies. J Spinal Disord Tech. 2002;15:118–126.
    1. Arjmand N, Plamondon A, Shirazi-Adl A, Parnianpour M, Larivière C. Predictive equations for lumbar spine loads in load-dependent asymmetric one- and two-handed lifting activities. Clin Biomech (Bristol, Avon) 2012;27:537–544.
    1. Quinnell R C, Stockdale H R, Willis D S. Observations of pressures within normal discs in the lumbar spine. Spine. 1983;8:166–169.
    1. Wilke H J, Neef P, Caimi M, Hoogland T, Claes L E. New in vivo measurements of pressures in the intervertebral disc in daily life. Spine. 1999;24:755–762.
    1. Sato K, Kikuchi S, Yonezawa T. In vivo intradiscal pressure measurement in healthy individuals and in patients with ongoing back problems. Spine. 1999;24:2468–2474.
    1. Brinckmann P, Frobin W, Hierholzer E, Horst M. Deformation of the vertebral end-plate under axial loading of the spine. Spine. 1983;8:851–856.
    1. Rolander S D, Blair W E. Deformation and fracture of the lumbar vertebral end plate. Orthop Clin North Am. 1975;6:75–81.
    1. Yoganandan N, Maiman D J, Pintar F. et al.Microtrauma in the lumbar spine: a cause of low back pain. Neurosurgery. 1988;23:162–168.
    1. Fields A J, Lee G L, Keaveny T M. Mechanisms of initial endplate failure in the human vertebral body. J Biomech. 2010;43:3126–3131.
    1. Hulme P A, Boyd S K, Ferguson S J. Regional variation in vertebral bone morphology and its contribution to vertebral fracture strength. Bone. 2007;41:946–957.
    1. Fields A J et al.Effects of endplate microstructure on biomechanical integrity Presented at: New Horizons in Intervertebral Disc Research. Philadelphia, PA: 2011
    1. Langrana N A, Kale S P, Edwards W T, Lee C K, Kopacz K J. Measurement and analyses of the effects of adjacent end plate curvatures on vertebral stresses. Spine J. 2006;6:267–278.
    1. Nekkanty S, Yerramshetty J, Kim D G. et al.Stiffness of the endplate boundary layer and endplate surface topography are associated with brittleness of human whole vertebral bodies. Bone. 2010;47:783–789.
    1. Nachemson A, Lewin T, Maroudas A, Freeman M A. In vitro diffusion of dye through the end-plates and the annulus fibrosus of human lumbar inter-vertebral discs. Acta Orthop Scand. 1970;41:589–607.
    1. Urban J P, Holm S, Maroudas A, Nachemson A. Nutrition of the intervertebral disk. An in vivo study of solute transport. Clin Orthop Relat Res. 1977;(129):101–114.
    1. Roberts S, Menage J, Urban J PG. Biochemical and structural properties of the cartilage end-plate and its relation to the intervertebral disc. Spine. 1989;14:166–174.
    1. Holm S, Maroudas A, Urban J P, Selstam G, Nachemson A. Nutrition of the intervertebral disc: solute transport and metabolism. Connect Tissue Res. 1981;8:101–119.
    1. Maroudas A, Stockwell R A, Nachemson A, Urban J. Factors involved in the nutrition of the human lumbar intervertebral disc: cellularity and diffusion of glucose in vitro. J Anat. 1975;120(Pt 1):113–130.
    1. Roberts S, Urban J P, Evans H, Eisenstein S M. Transport properties of the human cartilage endplate in relation to its composition and calcification. Spine. 1996;21:415–420.
    1. Urban M R, Fairbank J C, Etherington P J, Loh FRCA L, Winlove C P, Urban J P. Electrochemical measurement of transport into scoliotic intervertebral discs in vivo using nitrous oxide as a tracer. Spine. 2001;26:984–990.
    1. Bartels E M, Fairbank J C, Winlove C P, Urban J P. Oxygen and lactate concentrations measured in vivo in the intervertebral discs of patients with scoliosis and back pain. Spine. 1998;23:1–7, discussion 8.
    1. Benneker L M, Heini P F, Alini M, Anderson S E, Ito K. 2004 Young Investigator Award Winner: vertebral endplate marrow contact channel occlusions and intervertebral disc degeneration. Spine. 2005;30:167–173.
    1. Bernick S, Cailliet R. Vertebral end-plate changes with aging of human vertebrae. Spine. 1982;7:97–102.
    1. Bishop P B, Pearce R H. The proteoglycans of the cartilaginous end-plate of the human intervertebral disc change after maturity. J Orthop Res. 1993;11:324–331.
    1. Aigner T, Gresk-otter K R, Fairbank J C, von der Mark K, Urban J P. Variation with age in the pattern of type X collagen expression in normal and scoliotic human intervertebral discs. Calcif Tissue Int. 1998;63:263–268.
    1. Adams M A, McNally D S, Dolan P. “Stress” distributions inside intervertebral discs. The effects of age and degeneration. J Bone Joint Surg Br. 1996;78:965–972.
    1. Wong M, Siegrist M, Goodwin K. Cyclic tensile strain and cyclic hydrostatic pressure differentially regulate expression of hypertrophic markers in primary chondrocytes. Bone. 2003;33:685–693.
    1. Hulme P A, Ferguson S J, Boyd S K. Determination of vertebral endplate deformation under load using micro-computed tomography. J Biomech. 2008;41:78–85.
    1. Grant J P, Oxland T R, Dvorak M F. Mapping the structural properties of the lumbosacral vertebral endplates. Spine. 2001;26:889–896.
    1. Smith F P. Experimental biomechanics of intervertebral disc rupture through a vertebral body. J Neurosurg. 1969;30:134–139.
    1. Vernon-Roberts B, Pirie C J. Healing trabecular microfractures in the bodies of lumbar vertebrae. Ann Rheum Dis. 1973;32:406–412.
    1. Grant J P, Oxland T R, Dvorak M F, Fisher C G. The effects of bone density and disc degeneration on the structural property distributions in the lower lumbar vertebral endplates. J Orthop Res. 2002;20:1115–1120.
    1. Keller T S, Ziv I, Moeljanto E, Spengler D M. Interdependence of lumbar disc and subdiscal bone properties: a report of the normal and degenerated spine. J Spinal Disord. 1993;6:106–113.
    1. Aoki J, Yamamoto I, Kitamura N. et al.End plate of the discovertebral joint: degenerative change in the elderly adult. Radiology. 1987;164:411–414.
    1. Simpson E K, Parkinson I H, Manthey B, Fazzalari N L. Intervertebral disc disorganization is related to trabecular bone architecture in the lumbar spine. J Bone Miner Res. 2001;16:681–687.
    1. Homminga J, Weinans H, Gowin W, Felsenberg D, Huiskes R. Osteoporosis changes the amount of vertebral trabecular bone at risk of fracture but not the vertebral load distribution. Spine. 2001;26:1555–1561.
    1. Kurowski P, Kubo A. The relationship of degeneration of the intervertebral disc to mechanical loading conditions on lumbar vertebrae. Spine. 1986;11:726–731.
    1. Shirazi-Adl S A, Shrivastava S C, Ahmed A M. Stress analysis of the lumbar disc-body unit in compression. A three-dimensional nonlinear finite element study. Spine. 1984;9:120–134.
    1. Adams M A, Freeman B J, Morrison H P, Nelson I W, Dolan P. Mechanical initiation of intervertebral disc degeneration. Spine. 2000;25:1625–1636.
    1. Adams M A, McNally D S, Wagstaff J, Goodship A E. Abnormal stress concentrations in lumbar intervertebral discs following damage to the vertebral bodies: a cause of disc failure? Eur Spine J. 1993;1:214–221.
    1. Handa T, Ishihara H, Ohshima H, Osada R, Tsuji H, Obata K. Effects of hydrostatic pressure on matrix synthesis and matrix metalloproteinase production in the human lumbar intervertebral disc. Spine. 1997;22:1085–1091.
    1. Ishihara H, McNally D S, Urban J P, Hall A C. Effects of hydrostatic pressure on matrix synthesis in different regions of the intervertebral disk. J Appl Physiol. 1996;80:839–846.
    1. Lotz J C, Chin J R. Intervertebral disc cell death is dependent on the magnitude and duration of spinal loading. Spine. 2000;25:1477–1483.
    1. Walsh A J, Lotz J C. Biological response of the intervertebral disc to dynamic loading. J Biomech. 2004;37:329–337.
    1. Maroudas A, Stockwell R A, Nachemson A, Urban J. Factors involved in the nutrition of the human lumbar intervertebral disc: cellularity and diffusion of glucose in vitro. J Anat. 1975;120(Pt 1):113–130.
    1. Rajasekaran S, Babu J N, Arun R, Armstrong B R, Shetty A P, Murugan S. ISSLS prize winner: a study of diffusion in human lumbar discs: a serial magnetic resonance imaging study documenting the influence of the endplate on diffusion in normal and degenerate discs. Spine. 2004;29:2654–2667.
    1. Bisla R S, Marchisello P J, Lockshin M D, Hart D M, Marcus R E, Granda J. Auto-immunological basis of disk degeneration. Clin Orthop Relat Res. 1976;(121):205–211.
    1. Crock H V. Internal disc disruption. A challenge to disc prolapse fifty years on. Spine. 1986;11:650–653.
    1. Coppes M H, Marani E, Thomeer R T, Groen G J. Innervation of “painful” lumbar discs. Spine. 1997;22:2342–2349, discussion 2349-2350.
    1. Peng B, Hao J, Hou S. et al.Possible pathogenesis of painful intervertebral disc degeneration. Spine. 2006;31:560–566.
    1. Jackson H C II, Winkelmann R K, Bickel W H. Nerve endings in the human lumbar spinal column and related structures. J Bone Joint Surg Am. 1966;48:1272–1281.
    1. Serre C M, Farlay D, Delmas P D, Chenu C. Evidence for a dense and intimate innervation of the bone tissue, including glutamate-containing fibers. Bone. 1999;25:623–629.
    1. Artico M, Bosco S, Cavallotti C. et al.Noradrenergic and cholinergic innervation of the bone marrow. Int J Mol Med. 2002;10:77–80.
    1. Halvorson K G, Kubota K, Sevcik M A. et al.A blocking antibody to nerve growth factor attenuates skeletal pain induced by prostate tumor cells growing in bone. Cancer Res. 2005;65:9426–9435.
    1. Niv D, Gofeld M, Devor M. Causes of pain in degenerative bone and joint disease: a lesson from vertebroplasty. Pain. 2003;105:387–392.
    1. Fraser R D. The North American Spine Society (NASS) on lumbar discography. Spine. 1996;21:1274–1276.
    1. Wolfer L R, Derby R, Lee J E, Lee S H. Systematic review of lumbar provocation discography in asymptomatic subjects with a meta-analysis of false-positive rates. Pain Physician. 2008;11:513–538.
    1. Walsh T R, Weinstein J N, Spratt K F, Lehmann T R, Aprill C, Sayre H. Lumbar discography in normal subjects. A controlled, prospective study. J Bone Joint Surg Am. 1990;72:1081–1088.
    1. Carragee E J, Don A S, Hurwitz E L, Cuellar J M, Carrino J A, Herzog R. 2009 ISSLS Prize Winner: Does discography cause accelerated progression of degeneration changes in the lumbar disc: a ten-year matched cohort study. Spine. 2009;34:2338–2345.
    1. Carragee E J, Alamin T F. Discography. A review. Spine J. 2001;1:364–372.
    1. Carragee E J, Lincoln T, Parmar V S, Alamin T. A gold standard evaluation of the “discogenic pain” diagnosis as determined by provocative discography. Spine. 2006;31:2115–2123.
    1. Weinstein J, Claverie W, Gibson S. The pain of discography. Spine. 1988;13:1344–1348.
    1. Peng B, Chen J, Kuang Z, Li D, Pang X, Zhang X. Diagnosis and surgical treatment of back pain originating from endplate. Eur Spine J. 2009;18:1035–1040.
    1. Heggeness M H, Doherty B J. Discography causes end plate deflection. Spine. 1993;18:1050–1053.
    1. Yoganandan N, Larson S J, Pintar F A, Gallagher M, Reinartz J, Droese K. Intravertebral pressure changes caused by spinal microtrauma. Neurosurgery. 1994;35:415–421, discussion 421.
    1. Hebelka H, Gaulitz A, Nilsson A, Holm S, Hansson T. The transfer of disc pressure to adjacent discs in discography: a specificity problem? Spine. 2010;35:E1025–E1029.
    1. Esses S I, Moro J K. Intraosseous vertebral body pressures. Spine. 1992;17(6, Suppl):S155–S159.
    1. Arnoldi C C. Intraosseous hypertension. A possible cause of low back pain? Clin Orthop Relat Res. 1976;(115):30–34.
    1. Brown M F, Hukkanen M V, McCarthy I D. et al.Sensory and sympathetic innervation of the vertebral endplate in patients with degenerative disc disease. J Bone Joint Surg Br. 1997;79:147–153.
    1. Kuslich S D, Ulstrom C L, Michael C J. The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. Orthop Clin North Am. 1991;22:181–187.
    1. Modic M T, Steinberg P M, Ross J S, Masaryk T J, Carter J R. Degenerative disk disease: assessment of changes in vertebral body marrow with MR imaging. Radiology. 1988;166(1 Pt 1):193–199.
    1. Kuisma M, Karppinen J, Niinimäki J. et al.A three-year follow-up of lumbar spine endplate (Modic) changes. Spine. 2006;31:1714–1718.
    1. Vital J M, Gille O, Pointillart V. et al.Course of Modic 1 six months after lumbar posterior osteosynthesis. Spine. 2003;28:715–720, discussion 721.
    1. Marshman L A, Trewhella M, Friesem T, Bhatia C K, Krishna M. Reverse transformation of Modic type 2 changes to Modic type 1 changes during sustained chronic low-back pain severity. Report of two cases and review of the literature. J Neurosurg Spine. 2007;6:152–155.
    1. Braithwaite I, White J, Saifuddin A, Renton P, Taylor B A. Vertebral end-plate (Modic) changes on lumbar spine MRI: correlation with pain reproduction at lumbar discography. Eur Spine J. 1998;7:363–368.
    1. Ito M, Incorvaia K M, Yu S F, Fredrickson B E, Yuan H A, Rosenbaum A E. Predictive signs of discogenic lumbar pain on magnetic resonance imaging with discography correlation. Spine. 1998;23:1252–1258, discussion 1259-1260.
    1. Kokkonen S M, Kurunlahti M, Tervonen O. et al.Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed tomography diskography. Spine (Phila Pa 1976) 2002;27:2274–2278.
    1. O'Neill C, Kurgansky M, Kaiser J. et al.Accuracy of MRI for diagnosis of discogenic pain. Pain Physician. 2008;11:311–326.
    1. Thompson K J, Dagher A P, Eckel T S, Clark M, Reinig J W. Modic changes on MR images as studied with provocative diskography: clinical relevance—a retrospective study of 2457 disks. Radiology. 2009;250:849–855.
    1. Weishaupt D, Zanetti M, Hodler J. et al.Painful lumbar disk derangement: relevance of endplate abnormalities at MR imaging. Radiology. 2001;218:420–427.
    1. Ohtori S, Inoue G, Ito T. et al.Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic Type 1 or Type 2 changes on MRI. Spine. 2006;31:1026–1031.
    1. Yamauchi K Ohtori S Inoue G et al.Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplate of patients with vertebral endplates of patients with discogenic low back pain and Modic Type 1 or Type 2 changes on MRI Presented at: 33rd Annual Meeting of the International Society for the Study of the Lumbar Spine; Bergen, Norway; 2006
    1. Rahme R, Moussa R. The modic vertebral endplate and marrow changes: pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol. 2008;29:838–842.
    1. Crock H V. Internal disc disruption. A challenge to disc prolapse fifty years on. Spine. 1986;11:650–653.
    1. Ma X L, Ma J X, Wang T, Tian P, Han C. Possible role of autoimmune reaction in Modic Type I changes. Med Hypotheses. 2011;76:692–694.
    1. Miyamoto H, Saura R, Harada T, Doita M, Mizuno K. The role of cyclooxygenase-2 and inflammatory cytokines in pain induction of herniated lumbar intervertebral disc. Kobe J Med Sci. 2000;46:13–28.
    1. Ahn S H, Cho Y W, Ahn M W, Jang S H, Sohn Y K, Kim H S. mRNA expression of cytokines and chemokines in herniated lumbar intervertebral discs. Spine. 2002;27:911–917.
    1. Olmarker K, Larsson K. Tumor necrosis factor alpha and nucleus-pulposus-induced nerve root injury. Spine. 1998;23:2538–2544.
    1. Weiler C, Nerlich A G, Bachmeier B E, Boos N. Expression and distribution of tumor necrosis factor alpha in human lumbar intervertebral discs: a study in surgical specimen and autopsy controls. Spine. 2005;30:44–53, discussion 54.
    1. García-Cosamalón J, del Valle M E, Calavia M G. et al.Intervertebral disc, sensory nerves and neurotrophins: who is who in discogenic pain? J Anat. 2010;217:1–15.
    1. Olmarker K, Blomquist J, Strömberg J, Nannmark U, Thomsen P, Rydevik B. Inflammatogenic properties of nucleus pulposus. Spine. 1995;20:665–669.
    1. Cavanaugh J M. Rosemont, IL: American Academy of Orthopaedic Surgeons; 1996. Neural mechanism of idiopathic low back pain.
    1. Keshari K R, Lotz J C, Link T M, Hu S, Majumdar S, Kurhanewicz J. Lactic acid and proteoglycans as metabolic markers for discogenic back pain. Spine. 2008;33:312–317.
    1. Niinimäki J, Korkiakoski A, Parviainen O. et al.Association of lumbar artery narrowing, degenerative changes in disc and endplate and apparent diffusion in disc on postcontrast enhancement of lumbar intervertebral disc. MAGMA. 2009;22:101–109.
    1. Pfirrmann C W, Resnick D. 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. 2001;219:368–374.
    1. Katz M E, Teitelbaum S L, Gilula L A, Resnick D, Katz S J. Radiologic and pathologic patterns of end-plate-based vertebral sclerosis. Invest Radiol. 1988;23:447–454.
    1. Stäbler A, Bellan M, Weiss M, Gärtner C, Brossmann J, Reiser M F. MR imaging of enhancing intraosseous disk herniation (Schmorl's nodes) AJR Am J Roentgenol. 1997;168:933–938.
    1. Cheung K M, Samartzis D, Karppinen J, Luk K D. Are “patterns” of lumbar disc degeneration associated with low back pain?: new insights based on skipped level disc pathology. Spine. 2012;37:E430–E438.
    1. Coventry M B, Ghormley R K, Kernohan J W. The intervertebral disc: its microscopic anatomy and pathology. J Bone Joint Surg Br. 1945;27:460–474.
    1. Mok F P, Samartzis D, Karppinen J, Luk K D, Fong D Y, Cheung K M. 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. 2010;35:1944–1952.
    1. Hassler O. The human intervertebral disc. A micro-angiographical study on its vascular supply at various ages. Acta Orthop Scand. 1969;40:765–772.
    1. Hirsch C, Schajowicz F. Studies on structural changes in the lumbar annulus fibrosus. Acta Orthop Scand. 1952;22:184–231.
    1. Hilton R C, Ball J, Benn R T. Vertebral end-plate lesions (Schmorl's nodes) in the dorsolumbar spine. Ann Rheum Dis. 1976;35:127–132.
    1. Wagner A L, Murtagh F R, Arrington J A, Stallworth D. Relationship of Schmorl's nodes to vertebral body endplate fractures and acute endplate disk extrusions. AJNR Am J Neuroradiol. 2000;21:276–281.
    1. Wang Y, Videman T, Battié M C. Lumbar vertebral endplate lesions: prevalence, classification, and association with age. Spine. 2012;37:1432–1439.
    1. Takahashi K, Miyazaki T, Ohnari H, Takino T, Tomita K. Schmorl's nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals. Eur Spine J. 1995;4:56–59.
    1. Peng B, Wu W, Hou S, Shang W, Wang X, Yang Y. The pathogenesis of Schmorl's nodes. J Bone Joint Surg Br. 2003;85:879–882.
    1. Wang Y, Videman T, Battié M C. ISSLS prize winner: Lumbar vertebral endplate lesions: associations with disc degeneration and back pain history. Spine. 2012;37:1490–1496.
    1. Singer K, Edmondston S, Day R, Breidahl P, Price R. Prediction of thoracic and lumbar vertebral body compressive strength: correlations with bone mineral density and vertebral region. Bone. 1995;17:167–174.
    1. Hou Y, Luo Z. A study on the structural properties of the lumbar endplate: histological structure, the effect of bone density, and spinal level. Spine. 2009;34:E427–E433.
    1. Hansson T, Roos B. The relation between bone mineral content, experimental compression fractures, and disc degeneration in lumbar vertebrae. Spine. 1981;6:147–153.
    1. Wang Y, Battié M C, Videman T. A morphological study of lumbar vertebral endplates: radiographic, visual and digital measurements. Eur Spine J. 2012;21:2316–2323.
    1. Hilton R C, Ball J. Vertebral rim lesions in the dorsolumbar spine. Ann Rheum Dis. 1984;43:302–307.
    1. Vernon-Roberts B, Pirie C J. Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Rheumatol Rehabil. 1977;16:13–21.
    1. Grignon B, Grignon Y, Mainard D. et al.The structure of the cartilaginous end-plates in elder people. Surg Radiol Anat. 2000;22:13–19.
    1. White A A, Panjabi M M. Philadelphia, PA: J.B. Lippincott Co; 1990. Clinical Biomechanics of the Spine. 2nd ed.
    1. Lotz J C, Haughton V, Boden S D. et al.New treatments and imaging strategies in degenerative disease of the intervertebral disks. Radiology. 2012;264:6–19.

Source: PubMed

Sponsorit ja yhteistyökumppanit

Sairaudet

Huumeiden interventiot

3
Tilaa