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European Spine Journal

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01-09-2014 | Original Article

Determinants of evolution of endplate and disc degeneration in the lumbar spine: a multifactorial perspective

Authors: Nadja A. Farshad-Amacker, Alexander P. Hughes, Alexander Aichmair, Richard J. Herzog, Mazda Farshad

Published in: European Spine Journal | Issue 9/2014

Abstract

Purpose

Evolution and progression of disc and endplate bone marrow degeneration of the lumbar spine are thought to be multifactorial, yet, their influence and interactions are not understood. The aim of this study was to find association of potential predictors of evolution of degeneration of the lumbar spine.

Methods

Patients (n = 90) who underwent two lumbar magnetic resonance imaging (MRI) exams with an interval of at least 4 years and without any spinal surgery were included into the longitudinal cohort study with nested case–control analysis. Disc degeneration (DD) was scored according to the Pfirrmann classification and endplate bone marrow changes (EC) according to Modic in 450 levels on both MRIs. Potential variables for degeneration such as age, gender, BMI, scoliosis and sagittal parameters were compared between patients with and without evolution or progression of degenerative changes in their lumbar spine. A multivariate analysis aimed to identify the most important variables for progression of disc and endplate degeneration, respectively.

Results

While neither age, gender, BMI, sacral slope or the presence of scoliosis could be identified as progression factor for DD, a higher lordosis was observed in subjects with no progression (49° ± 11° vs 43° ± 12°; p = 0.017). Progression or evolution of EC was only associated with a slightly higher degree of scoliosis (10° ± 10° vs 6° ± 9°; p = 0.04) and not to any of the other variables.

Conclusion

While a coronal deformity of the lumbar spine seems associated with evolution or progression of EC, a higher lumbar lordosis is protective for radiographic progression of DD. This implies that scoliotic deformity and lesser lumbar lordosis are associated with higher overall degeneration of the lumbar spine.

Zirbel SA, Stolworthy DK, Howell LL, Bowden AE (2013) Intervertebral disc degeneration alters lumbar spine segmental stiffness in all modes of loading under a compressive follower load. Spine J 13–9:1134–1147CrossRef

Tyndyk MA, McGarry JP, Barron V, McHugh PE, O’Mahoney D, Tawackoli W, Liebschner MA (2008) Effects of intervertebral disk degeneration on the flexibility of the human thoracolumbar spine. J Long Term Eff Med Implants 18–4:269–288CrossRef

Tanaka N, An HS, Lim TH, Fujiwara A, Jeon CH, Haughton VM (2001) The relationship between disc degeneration and flexibility of the lumbar spine. Spine J 1–1:47–56CrossRef

Adams MA, Pollintine P, Tobias JH, Wakley GK, Dolan P (2006) Intervertebral disc degeneration can predispose to anterior vertebral fractures in the thoracolumbar spine. J Bone Miner Res 21–9:1409–1416CrossRef

Zukowski LA, Falsetti AB, Tillman MD (2012) The influence of sex, age and BMI on the degeneration of the lumbar spine. J Anat 220–1:57–66CrossRef

Kuisma M, Karppinen J, Haapea M, Niinimaki J, Ojala R, Heliovaara M, Korpelainen R, Kaikkonen K, Taimela S, Natri A, Tervonen O (2008) Are the determinants of vertebral endplate changes and severe disc degeneration in the lumbar spine the same? A magnetic resonance imaging study in middle-aged male workers. BMC Musculoskelet Disord 9:51PubMedCentralPubMedCrossRef

Keorochana G, Taghavi CE, Lee KB, Yoo JH, Liao JC, Fei Z, Wang JC (2011) Effect of sagittal alignment on kinematic changes and degree of disc degeneration in the lumbar spine: an analysis using positional MRI. Spine (Phila Pa 1976) 36–11:893–898CrossRef

Kauppila LI (2009) Atherosclerosis and disc degeneration/low-back pain—a systematic review. Eur J Vasc Endovasc Surg 37–6:661–670CrossRef

Ergun T, Lakadamyali H, Sahin MS (2010) The relation between sagittal morphology of the lumbosacral spine and the degree of lumbar intervertebral disc degeneration. Acta Orthop Traumatol Turc 44–4:293–299CrossRef

10.

Battie MC, Videman T, Kaprio J, Gibbons LE, Gill K, Manninen H, Saarela J, Peltonen L (2009) The Twin Spine Study: contributions to a changing view of disc degeneration. Spine J 9–1:47–59CrossRef

11.

Battie MC, Videman T, Gill K, Moneta GB, Nyman R, Kaprio J, Koskenvuo M (1991) 1991 Volvo Award in clinical sciences. Smoking and lumbar intervertebral disc degeneration: an MRI study of identical twins. Spine (Phila Pa 1976) 16–9:1015–1021CrossRef

12.

Wang Y, Videman T, Battie MC (2012) ISSLS prize winner: lumbar vertebral endplate lesions: associations with disc degeneration and back pain history. Spine (Phila Pa 1976) 37–17:1490–1496CrossRef

13.

Albert HB, Briggs AM, Kent P, Byrhagen A, Hansen C, Kjaergaard K (2011) The prevalence of MRI-defined spinal pathoanatomies and their association with modic changes in individuals seeking care for low back pain. Eur Spine J 20–8:1355–1362CrossRef

14.

Madan SS, Rai A, Harley JM (2003) Interobserver error in interpretation of the radiographs for degeneration of the lumbar spine. Iowa Orthop J 23:51–56PubMedCentralPubMed

15.

Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26–17:1873–1878CrossRef

16.

Modic MT, Pavlicek W, Weinstein MA, Boumphrey F, Ngo F, Hardy R, Duchesneau PM (1984) Magnetic resonance imaging of intervertebral disk disease. Clinical and pulse sequence considerations. Radiology 152–1:103–111CrossRef

17.

Berlemann U, Jeszenszky DJ, Buhler DW, Harms J (1999) The role of lumbar lordosis, vertebral end-plate inclination, disc height, and facet orientation in degenerative spondylolisthesis. J Spinal Disord 12–1:68–73

18.

Schwab F, el-Fegoun AB, Gamez L, Goodman H, Farcy JP (2005) A lumbar classification of scoliosis in the adult patient: preliminary approach. Spine (Phila Pa 1976) 30–14:1670–1673CrossRef

19.

Roussouly P, Pinheiro-Franco JL (2011) Sagittal parameters of the spine: biomechanical approach. Eur Spine J 20 Suppl 5:578–585PubMedCrossRef

20.

Umehara S, Zindrick MR, Patwardhan AG, Havey RM, Vrbos LA, Knight GW, Miyano S, Kirincic M, Kaneda K, Lorenz MA (2000) The biomechanical effect of postoperative hypolordosis in instrumented lumbar fusion on instrumented and adjacent spinal segments. Spine (Phila Pa 1976) 25–13:1617–1624CrossRef

21.

Min JH, Jang JS, Jung B, Lee HY, Choi WC, Shim CS, Choi G, Lee SH (2008) The clinical characteristics and risk factors for the adjacent segment degeneration in instrumented lumbar fusion. J Spinal Disord Tech 21–5:305–309CrossRef

22.

Adams MA, McMillan DW, Green TP, Dolan P (1996) Sustained loading generates stress concentrations in lumbar intervertebral discs. Spine (Phila Pa 1976) 21–4:434–438CrossRef

Title: Determinants of evolution of endplate and disc degeneration in the lumbar spine: a multifactorial perspective
Authors: Nadja A. Farshad-Amacker
Alexander P. Hughes
Alexander Aichmair
Richard J. Herzog
Mazda Farshad
Publication date: 01-09-2014
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 9/2014
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-014-3382-z

At a glance: The STEP trials

Springer Medicine

Determinants of evolution of endplate and disc degeneration in the lumbar spine: a multifactorial perspective

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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