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Disc degeneration contributes to the denser bone in the subendplate but not in the vertebral body in patients with lumbar spinal stenosis or disc herniation

  • Yin Ding
    Affiliations
    Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China

    Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, 29 Xinglong Alley, Changzhou, China
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  • Jia-Yu Chen
    Affiliations
    Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
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  • Jia-Chen Yang
    Affiliations
    Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
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  • Ruo-Yao Li
    Affiliations
    Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
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  • Yong-Jie Yin
    Affiliations
    Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
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  • Author Footnotes
    1 Co-corresponding author and share senior authorship.
    Jian-Ting Chen
    Footnotes
    1 Co-corresponding author and share senior authorship.
    Affiliations
    Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
    Search for articles by this author
  • Author Footnotes
    1 Co-corresponding author and share senior authorship.
    Qing-An Zhu
    Correspondence
    Corresponding author. Division of Spine Surgery, Department of Orthopaedics, Southern Medical University Nanfang Hospital, 1838 North Guangzhou Ave, Guangzhou 510515, China.
    Footnotes
    1 Co-corresponding author and share senior authorship.
    Affiliations
    Division of Spine Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Ave, Guangzhou 510515, China
    Search for articles by this author
  • Author Footnotes
    1 Co-corresponding author and share senior authorship.
Published:October 03, 2022DOI:https://doi.org/10.1016/j.spinee.2022.09.010

      Abstract

      BACKGROUND CONTEXT

      It is commonly believed that decreased bone quality would lead to endplate degeneration and arthritic changes in the facet joints, and thus accelerated disc degeneration (DD). However, some more detailed studies of vertebral bone structure have found that bone mineral density (BMD) in the vertebral body is increased rather than decreased in moderate or greater disc degeneration. The relationship between BMD and DD still needs further study. MRI-based vertebral bone quality scores have been shown to be effective in reflecting BMD, rendering a new way to evaluate the changes of vertebral body bone with DD using MRI alone.

      PURPOSE

      To evaluate MRI-based vertebral bone quality and Pfirrmann grades in patients with lumbar spinal stenosis or disc herniation, and to identify if DD is associated with denser bone around the endplate.

      STUDY DESIGN/SETTING

      A single-center, retrospective cohort study.

      PATIENT SAMPLE

      A total of 130 patients with lumbar disc herniation and lumbar spinal stenosis from January 2019 to November 2020 who had a complete dual-energy X-ray absorptiometry scan and noncontrast lumbosacral spine MRI data.

      OUTCOME MEASURES

      The vertebral bone quality score (VBQ) and sub-endplate bone quality score (EBQ) was calculated as a ratio of the signal intensity of the vertebral bodies and sub-endplate regions to the signal intensity of the cerebrospinal fluid at L3 on the mid-sagittal T1-weighted MRI images, respectively. The Pfirrmann grades of the lumbar discs were assessed as well.

      METHODS

      The age, gender, body mass index, and T-score of the lumbar spine of the patients were collected. The degeneration grades of the lumbar discs were evaluated according to the Pfirrmann classification. VBQ and EBQ were measured through T1-weighted lumbar MRI. The VBQ and EBQ scores were compared between cranial and caudal sides. The correlation between MRI-based bone quality and DD was calculated. A linear regression model was used to examine the association between DD and adjacent EBQ and VBQ.

      RESULTS

      This study included 569 lumbar segments from 130 inpatients. Cranial and caudal EBQ decreased with the increase of the Pfirrmann grade. The discs with Pfirrmann grade 5 had significantly lower caudal EBQ than the discs with Pfirrmann grades 2, 3, and 4. In the osteoporosis patients, the Pfirrmann grades negatively correlated both with the cranial EBQ and caudal EBQ. Pfirrmann grade greater than 4 was an independent contributor to the cranial EBQ, whereas greater than 3 was an independent contributor to the caudal EBQ.

      CONCLUSIONS

      Disc degeneration grades correlated with the EBQ but not with the VBQ. In patients with lumbar spinal stenosis or disc herniation, DD contributes to the denser bone in the sub-endplate, but not in the whole vertebral body.

      Keywords

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