Endplate lesions in the lumbar spine: a novel MRI-based classification scheme and epidemiology in low back pain patients

• Published in: European spine journal Vol. 27; no. 11; pp. 2854 - 2861
• Main Authors: Brayda-Bruno, Marco, Albano, Domenico, Cannella, Guglielmo, Galbusera, Fabio, Zerbi, Alberto
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.2018; Springer Nature B.V
• Subjects: Back pain; Classification; Classification schemes; Degeneration; Intervertebral discs; Low back pain; Magnetic resonance imaging; Medicine; Medicine & Public Health; Neurosurgery; NMR; Nuclear magnetic resonance; Original Article; Pain; Spine (lumbar); Surgical Orthopedics; Classification system; Modic changes; Endplate lesions; Endplate defects; Pfirrmann grading
• ISSN: 0940-6719; 1432-0932; 1432-0932
• DOI: 10.1007/s00586-018-5787-6

Purpose The aims of the study were to introduce a classification scheme for endplate lesions based on T2-weighted magnetic resonance imaging and to detect possible associations between endplate lesions and other variables such as age, sex, disc degeneration and Modic changes in a large population. Methods MRI images of 996 low back pain patients were collected. All intervertebral spaces were classified as “normal”, “wavy/irregular”, “notched”, “Schmorl’s node” and “fracture”. The associations between endplate lesions and age, sex, disc degeneration and Modic changes were determined in the considered population. Results The most common endplate lesions were “notched” and “Schmorl’s nodes”. The prevalence was higher among the male subjects. In most patients (62.8%), no endplate lesions were detected, with a significant difference between male (57.5%) and female subjects (67.9%) ( p  < 0.001). Lesions were found to be associated with intervertebral disc degeneration (relative risk 2.49) and signal alterations (relative risk 3.08). Fleiss kappas of 0.73 and 0.89 were, respectively, assessed for the inter- and intra-observer reliabilities of the new classification system. Conclusions Endplate lesions were detected, classified with a novel scheme and analysed in a large population of patients suffering from low back pain based on MRI images. The reliability of the novel classification system was demonstrated. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.