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Lumbar Vertebral Endplate Lesions: Prevalence, Classification, and Association With Age

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

doi: 10.1097/BRS.0b013e31824dd20a

Study Design. A cross-sectional autopsy study.

Objective. This study investigated the prevalence of endplate lesions, classified them on the basis of morphological features, and determined their distribution patterns through direct measurements of cadaveric spines as well as examining their associations with age.

Summary of Background Data. Endplate lesions may play a role in disc degeneration and back pain; however, related research has been rare. While Schmorl's nodes have received some attention, other endplate pathologies have been largely ignored. A systematic study of endplate lesions is needed to reveal the types and prevalence of lesions present in the adult lumbar spine.

Methods. We studied 1148 vertebral endplates (L1–S1) from the cadaveric spines of 136 men (mean age, 52 yr). On the basis of morphological characteristics, 4 types of endplate lesions were identified, including Schmorl's nodes, fracture, erosion, and calcification. The lesion location, size, and involved endplate components were evaluated to depict their distribution patterns. The associations between endplate lesion findings and age were also examined.

Results. Endplate lesions were found in 45.6% of lumbar vertebral endplates. Schmorl's nodes were the most common and usually were small, located centrally, and most common in the upper lumbar region. Erosion and calcification lesions were relatively large and most common in the lower lumbar region. The presence of lesions on 1 endplate of the disc was associated with presence of lesions on the opposing endplate (odds ratio = 8.0, P < 0.001). Greater age was associated with the presence of each type of endplate lesion.

Conclusion. Endplate lesions are common and tend to affect both adjacent endplates of a disc simultaneously. The distribution patterns of the various types of endplate lesions differ, suggesting that they may have different pathogenic origins. Age or associated factors may play an important role in the pathogenesis of endplate lesions.

We studied 1148 cadaveric vertebral endplates and found that endplate lesions are very common in adult lumbar spines. Four diff erent types of endplate lesions with distinct distributions were identified, including Schmorl's nodes, fracture, erosion, and calcification. Age or associated factors play an important role in the pathogenesis of endplate lesions.

*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, Faculty of Rehabilitation Medicine, University of Alberta, 3-44 Corbett Hall, Edmonton, AB T6G 2G4, Canada; E-mail:

Acknowledgment date: November 2, 2011. Revision date: January 25, 2012. Acceptance date: January 30, 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.

© 2012 Lippincott Williams & Wilkins, Inc.