Elsevier

World Neurosurgery

Volume 141, September 2020, Pages e423-e430
World Neurosurgery

Original Article
Lumbar Vertebral Endplate Defects on Magnetic Resonance Imaging in Degenerative Spondylolisthesis: Novel Classification, Characteristics, and Correlative Factor Analysis

https://doi.org/10.1016/j.wneu.2020.05.163Get rights and content

Background

Endplate defects are commonly seen in patients with lumbar degenerative disease. However, little is known about the presence of endplate defects in patients with degenerative spondylolisthesis (DS). In the present study, we have introduced a classification system for endplate defects in patients with DS using routine magnetic resonance imaging findings and explored the correlative factors.

Methods

Endplate defects were classified into 3 major categories (rim defects, focal defects, and erosive defects) and 5 subtypes (anterior type, posterior type, arc type at the anterior rim, notch type, and Schmorl's nodes). The incidence rates of the endplate defects were compared between the slippage and nonslippage levels. The correlations between the endplate defects and age, sex, disc degeneration, Modic changes (MCs), body mass index, slippage segment, and slippage degree were analyzed.

Results

Endplate defects were present in 47.43% of the endplates in DS. The most common endplate defects were rim defects. The occurrence of endplate defects, especially anterior defects, was more common at the slippage levels. Endplate defects were associated with age and closely related to MCs and the severity of disc degeneration. The slippage degree, slippage segment, body mass index, and sex differences were not associated with endplate defects in our study. The results obtained using this novel classification system were stable and consistent.

Conclusions

The results from the present study have shown that the novel radiological classification system of endplate defects is reliable. Endplate defects were associated with slippage but not with the slippage degree or slippage segment differences in DS. The correlation between endplate defects and age and between MCs and disc degeneration were important features on the magnetic resonance imaging scans of patients with DS.

Introduction

Degenerative spondylolisthesis (DS) is a common disease leading to low back pain, and the prevalence of DS is age- and sex-specific.1 Few people develop DS before 50 years of age, and DS occurs more often in women. The development of DS is associated with many risk factors, including age, morphometric changes in the intervertebral discs and vertebral bodies,2 facet tropism,3 and back muscle weakness.4

Vertebral endplates have porous structures and are located between the vertebral trabeculae and intervertebral discs. Vertebral endplates not only have load transmission function, but also serve as a nutrition supply pathway to the intervertebral discs.5 The peripheral regions of the endplates are thicker than the central regions.6 The stiffness and strength of endplates increase from the center toward the periphery.7 The structural integrity and normal morphology of endplates are important to their biomechanical function. Abnormal morphology changes are risk factors for endplate fraction and lumbar intervertebral disc herniation.8,9

Endplate defects are pathological changes in the inferior or superior surface of a vertebra. The classification schemes of endplate defects have been determined from autopsy and imaging studies. Some types of endplate defects have been described in previous studies, such as Schmorl's nodes, notches, fractures, erosion, corner defects, and local defects.10, 11, 12 The phenotypic changes between the different defect types are various.13 A flattening shape of an endplate has been associated with intervertebral disc degeneration.11,14 Endplate defects have also been associated with Modic changes (MCs).15 To the best of our knowledge, no classification system for endplate defects has been established for DS using magnetic resonance imaging (MRI) findings. Thus, the characteristics of endplate defects in the presence of DS and the correlative factors are unknown.

The purpose of the present study was to establish a classification system for endplate defects using the MRI findings of patients with DS, identify their prevalence and distribution patterns, and define the effects of slippage on endplate defects and the association of endplate defects with disc degeneration, MCs, age, sex, and body mass index (BMI).

Section snippets

Population and Imaging Technique

A total of 204 patients with monosegment DS seeking medical care in our hospital from September 2018 to September 2019 were considered for inclusion in the present study. T1- and T2-weighted MRI scans, lumbar lateral radiographs, and the medical records of each patient were retrospectively collected. The MRI scans had to include the endplates from the T12 inferior endplate (IEP) to the S1 superior endplate (SEP) of each patient. Patients with a history of back surgery, vertebral fractures,

Results

A total of 159 patients (35 men and 124 women) were included, with 1908 endplates. Their age ranged from 28 to 81 years (average age, 60.6 ± 8.7 years). The slippage segments included 14 at L3, 130 at L4, and 15 at L5. Defects were present in 905 endplates (47.43%). MCs were observed in 222 endplates (11.64%), including 15 type 1 MCs, 192 type 2 MCs, and 15 type 3 MCs. The prevalence and distribution of the endplate defects, MCs and disc degeneration grades are presented in Table 1. The

Discussion

Lumbar DS is a major cause of spinal canal stenosis and low back pain.17 Some risk factors contribute to the process of DS development, including age, disc degeneration, abnormal sagittal spinopelvic alignment, higher BMI, and facet joint degeneration.1,18, 19, 20 Endplate features, such as thickness and porosity, are strongly influenced by mechanical loading.21 In a previous autopsy study, vertebral endplate lesions were found in 72% of the lumbar spines and 32.8% of the endplates.22 Endplate

Conclusions

Endplate defects in DS were observed on MRI studies and were classified using a novel and reliable classification system. The classification could identify defect differences between the slippage segments and other levels. Endplate defects were associated with slippage but not with the slippage degree or slippage segment difference in those with DS. The prevalence and distribution of endplate defects and their associations with age, MCs, and disc degeneration were important features on MRI

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    Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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