Morphometrics and Lesions of Vertebral End Plates Are Associated with Lumbar Disc Degeneration: Evidence from Cadaveric Spines

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Background:Prior studies have suggested that vertebral end plate morphometrics and lesions may play a role in disc degeneration. However, most prior end plate studies have been based on radiographic images, and findings of associations between end plate morphometrics (measurements of size and shape) and disc degeneration remain controversial. The present study investigated the prevalence of vertebral end plate lesions and determined end plate morphometrics through direct measurements of cadaveric spines, and it examined the association of these factors with disc degeneration.Methods:We studied 600 vertebral end plates and 313 intervertebral discs from the cadaveric lumbosacral spines of seventy-six men (mean age, fifty-one years). Discography was performed to evaluate disc degeneration as indicated by disruption of the anulus fibrosus. The shape of the vertebral end plate and the presence of any lesions were visually evaluated. Lesions were rated as absent, small to moderate, or large. In addition, each end plate was digitized to quantify its area, circularity, and concavity. The association of end plate morphometrics and lesions with disc degeneration was examined.Results:Vertebral end plate lesions were found in 72% (fifty-five) of the seventy-six lumbar spines and in 32.8% (197) of the 600 end plates. The presence of end plate lesions was associated with disc degeneration, with larger lesions being associated with more severe disc degeneration (odds ratio, 2.31 for small to moderate lesions [p < 0.01] and 3.54 for large lesions [p < 0.001]). Greater end plate area was also associated with more severe disc degeneration (odds ratio, 1.2 per cm2 [p < 0.05]).Conclusions:Vertebral end plate lesions were common and were associated with adjacent disc degeneration, with greater lesion size being associated with more severe disc degeneration. End plate morphometrics, particularly greater end plate size, may also play a role in the pathogenesis of disc degeneration.Clinical Relevance:This study suggests that the integrity of the vertebral end plate is essential to maintaining disc health. The prevalence of end plate lesions may be underestimated on standard clinical images.

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