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ISSLS Prize Winner: Lumbar Vertebral Endplate LesionsAssociations With Disc Degeneration and Back Pain History

Wang, Yue, MD, PhD*,†; Videman, Tapio, MD, PhD*; Battié, Michele C., PhD*

doi: 10.1097/BRS.0b013e3182608ac4

Study Design. An autopsy study.

Objective. To investigate associations between various types of lumbar endplate lesions, disc degeneration (DD), and back pain history.

Summary of Background Data. The well-innervated vertebral endplate has been suspected as a source of back pain. Previously, we observed 4 types of lumbar endplate lesions with distinct morphological characteristics. Their roles in DD and back pain remain unclear.

Methods. From a lumbar spine archive of 136 men (mean age, 52 yr), back pain, back injury, and occupation history data for 69 subjects and discography data for 443 discs from 109 subjects were available for study. Back pain history was categorized as none, occasional, or frequent. DD was judged from discography. Endplate lesions were classified as Schmorl's nodes, fracture, erosion, or calcification, and lesion size was rated as none, small, moderate, or large. Associations between endplate lesions and DD, back pain history, back injury, and occupation history were examined.

Results. Presence of endplate lesions was associated with frequent (odds ratio [OR] = 2.57) but not occasional back pain. However, large endplate lesions were associated with both occasional (OR = 8.68) and frequent (OR = 17.88) back pain. This association remained after further controlling for DD. Also, the presence of each type of endplate lesion was associated with adjacent DD (OR = 2.40–9.71), with larger lesions associated with more severe DD. Endplate erosion lesions were more strongly associated with adjacent DD than Schmorl's nodes. Although back injury history was associated with the presence of fracture and erosion lesions, heavy occupation was associated with the presence of Schmorl's nodes.

Conclusion. Endplate lesions are associated with back pain as well as being closely associated with adjacent DD, with a clear dosage effect. Different types of endplate lesions seem to have different magnitudes of associations with DD. Lumbar endplate lesions may be an important key to better understand both DD and back pain.

Using cadaveric material and pain history data, we revealed an association between lumbar bony endplate lesions and back pain. Endplate lesions were closely associated with adjacent disc degeneration, with a clear dosage effect. Lumbar endplate lesions may be an important key to better understand both disc degeneration and back pain.

*Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada

Department of Orthopedic Surgery, The First Affiliated Hospital of Medical School of Zhejiang University, Hangzhou, People's Republic of China.

Address correspondence and reprint requests to Michele C. Battié, PhD, 3- 44, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada T6G 2G4; E-mail:

Acknowledgment date: October 21, 2011. Revision date: March 26, 2012. Acceptance date: May 13, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Yue Wang, MD, PhD, is supported by Alberta Innovates-Health Solutions (AIHS) and the China Scholarship Council (CSC), and Michele C. Battié, PhD, is supported by the Canada Research Chairs program.

© 2012 Lippincott Williams & Wilkins, Inc.