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European Radiology
Published in: European Radiology 6/2017

01-06-2017 | Musculoskeletal

The intervertebral disc, the endplates and the vertebral bone marrow as a unit in the process of degeneration

Authors: Nadja A. Farshad-Amacker, Alexander Hughes, Richard J. Herzog, Burkhardt Seifert, Mazda Farshad

Published in: European Radiology | Issue 6/2017

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Abstract

Objectives

The association of disc degeneration (DD) and vertebral endplate degeneration (EPD) is still not well understood. This study aimed to find segmental predictive risk factors for DD and EPD and to illuminate associations of the disc, endplate and bone marrow changes in the process of degeneration.

Methods

After institutional review board approval, 450 lumbar levels, followed up with MRI for at least 4 years, were retrospectively graded for DD according to Pfirrmann (PFG), for EPD according to the endplate score (EPS) and according to the presence, extension and type of Modic changes (MC). Clustered logistic regression and multivariate analysis was applied in nested, matched case-control subgroups to evaluate potential local risk factors for progression.

Results

An EPS score of  ≥4 was identified as an independent risk factor for progression of DD (OR = 2.32, 95%CI:1.07–5.01,p = 0.03) and MC (OR = 5.49,95%CI:2.30–13.10,p < 0.001). Progression of DD was significantly accompanied by progression or evolution of MC (OR = 12.25,95%CI:1.49–100.6,p = 0.02) and with progression of EPS (OR = 1.71, 95%CI:1.00–1.05, p = 0.01). Once advanced DD has occurred, it becomes a risk factor for progression in EPS (OR = 2.24,95%CI:1.23–4.12,p < 0.01).

Conclusions

The degenerative processes in the disc, endplate and bone marrow are highly associated. An EPS ≥ 4 is an independent risk factor for DD and MC progression in a population with low back pain.

Key Points

• The degenerative processes in the disc, endplate and bone marrow are associated.
• An endplate score ≥4 is a risk factor for DD and MC progression.
• Modic changes are last to occur in the development of segmental intervertebral degeneration.
• A new segmental grading system is suggested.
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Metadata
Title
The intervertebral disc, the endplates and the vertebral bone marrow as a unit in the process of degeneration
Authors
Nadja A. Farshad-Amacker
Alexander Hughes
Richard J. Herzog
Burkhardt Seifert
Mazda Farshad
Publication date
01-06-2017
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-016-4584-z

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