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Severe osteoporotic vertebral compression fracture (SOVCF) is frequently complicated by endplatedisc complex (EDC) injury. While percutaneous kyphoplasty (PKP) can offer rapid analgesia and facilitate early activity, it does not restore vertebral height and may result in intervertebral leakage and untreated EDC injury.This study aimed to evaluate the clinical outcomes of percutaneous functional spinal unit cementoplasty (PFSUP) for SOVCF complicated by EDC injury and compare its clinical and imaging outcomes with PKP. This was a retrospective case-control study. Patients with SOVCF complicated with EDC injury between January 1, 2018, and December 31, 2019, were recruited and assigned to the PKP group and PFSUP group based on their treatment procedures Back pain was evaluated using the visual analog scale (VAS) and daily life activities were assessed using the Oswestry disability index (ODI). X-rays were employed to observe the presence and location of cement leakage, as well as to measure the sagittal vertical axis (SVA) and local kyphosis angle (LKA). Loss of correction was calculated by subtracting the LKA after surgery from that at the final follow-up visit Subsequent vertebral fracture (SVF) was confirmed using the Genant semi-quantitative method and/or MRI. A total of 64 patients were included in this study. Among them 41 cases were assigned to the PKP group (28 females, 74.8 years on average), while the remaining 23 cases were assigned to the PFSUP group (15 females, 76.3 years on average). All surgical interventions were successfully completed without major complications. Compared to the PKP group, the PFSUP group had longer operation time (70.28 ± 11.44 vs 44.5 ± 10.12, P< 0.001) higher frequencies of radiation exposure (97.6 ± 19.85 vs 38.6 ± 9.53, P< 0.001), and a lower cement leakage rate (26.1% vs. 41.5%, P< 0.001). One day after surgery and at the final follow-up the PFSUP group had lower VAS and ODI scores, as well as lower LKA and Sva values compared with the PKP group (all P< .001). At the final follow-up visit, the PFSUP group demonstrated a lower loss of correction (4.38 ± 2.71 vs. 10.19 ± 3.41 P< 0.001) and a lower SVF rate compared to the PKP group (21.7% vs. 31.7%, P< 0.001). PFSUP outperformed PKP in alleviating pain restoring and maintaining sagittal balance, and lowering the incidence of cement leakage and SVF for SOVCF with EDC injury However, PFSUP was associated with longer operation time and high radiation exposure frequencies. [ABSTRACT FROM AUTHOR]

Study Design. Diagnostic test study. Objective. To determine the reliability and validity or diagnostic accuracy of two previously described endplate structural defect (EPSD) assessment methods. Summary of Background Data. Studies of EPSD may further the understanding of pathoanatomic mechanisms underlying back pain. However, clinical imaging methods used to document EPSD have not been validated, leaving uncertainty about what the observations represent. Materials and Methods. Using an evaluation manual, 418 endplates on CT sagittal slices obtained from 19 embalmed cadavers (9 men and 10 women, aged 62-91 yr) were independently assessed by two experienced radiologists and a novice for EPSD using the two methods. The corresponding micro-CT (µCT) from the harvested T7-S1 spines were assessed by another independent rater with excellent intra-rater reliability (k=0.96). Results. Inter-rater reliability was good for the presence (k =0.60-0.69) and fair for specific phenotypes (k= 0.43-0.58) of EPSD. Erosion, for which the Brayda-Bruno classification lacked a category, was mainly (82.8%) classified as wavy/irregular, while many notched defects (n =15, 46.9%) and Schmorl's nodes (n =45, 79%) were recorded as focal defects using Feng's classification. When compared to µCT, endplate fractures (n= 53) and corner defects (n= 28) were routinely missed on CT. Endplates classified as wavy/irregular on CT corresponded to erosion (n =29, 21.2%), jagged defects (n =21, 15.3%), calcification (n =19, 13.9%), and other phenotypes on µCT. Some focal defects on CT represented endplate fractures (n= 21, 27.6%) on µCT. Overall, with respect to the presence of an EPSD, there was a sensitivity of 70.9% and a specificity of 79.1% using Feng's method, and 79.5% and 57.5% using Brayda-Bruno's method. Poor to fair inter-rater reliability (k =0.26-0.47) was observed for defect dimensions. Conclusion. There was good inter-rater reliability and evidence of criterion validity supporting assessments of EPSD presence using both methods. However, neither method contained all needed EPSD phenotypes for optimal sensitivity, and specific phenotypes were often misclassified. [ABSTRACT FROM AUTHOR]

Management of patients suffering from low back pain (LBP) is challenging and requires development of diagnostic techniques to identify specific patient subgroups and phenotypes in order to customize treatment and predict clinical outcome. The Back Pain Consortium (BACPAC) Research Program Spine Imaging Working Group has developed standard operating procedures (SOPs) for spinal imaging protocols to be used in all BACPAC studies. These SOPs include procedures to conduct spinal imaging assessments with guidelines for standardizing the collection, reading/grading (using structured reporting with semi-quantitative evaluation using ordinal rating scales), and storage of images. This article presents the approach to image acquisition and evaluation recommended by the BACPAC Spine Imaging Working Group. While the approach is specific to BACPAC studies, it is general enough to be applied at other centers performing magnetic resonance imaging (MRI) acquisitions in patients with LBP. The herein presented SOPs are meant to improve understanding of pain mechanisms and facilitate patient phenotyping by codifying MRI-based methods that provide standardized, non-invasive assessments of spinal pathologies. Finally, these recommended procedures may facilitate the integration of better harmonized MRI data of the lumbar spine across studies and sites within and outside of BACPAC studies.

In previous studies of disc degeneration, the structural and mechanical properties of the endplate were often neglected. In this paper, the station legislation was used to construct an animal model of minor trauma disc degeneration, and the mechanism of disc degeneration was further investigated by observing the changes of mesoscopic structure and developing the mechanical properties of endplate bone.Twenty-eight 6-month-old Japanese white rabbits were divided into two groups: control group and experimental group. An animal model of intervertebral disc degeneration was established by upright experiment in the experimental group. The bone mesoscopic structures in different areas of each endplate were observed by histological and imaging methods, and the mechanical properties of the endplates were measured by indentation method. The two groups of data were compared by one-way ANOVA.After the experimental animals stood for 17 weeks, The experimental group showed the characteristics of early disc degeneration. The microstructure of the degenerative group showed that the end plate mineralization degree was higher, the bone mass was larger, and the number and thickness of bone trabeculae were larger. The results of indentation test showed that the mechanical properties of the degeneration group were enhanced, and the lower endplate was obviously enhanced.We successfully established a model of human disc degeneration with non invasive trauma and more consistent with the process of human disc degeneration through the standing experiment. In the experimental group, the internal structure of the endplate was dense and pore distance was reduced. The change of bone mesoscopic structure further affects the endplate, resulting in the enhancement of the mechanical properties of the endplate after intervertebral disc degeneration. The reduction of the pore distance and the narrowing of the internal channel structure of the endplate also hinder the nutrition supply of the intervertebral disc, which may be the key reason affecting the degeneration of the intervertebral disc. A biomechanical method for investigating the mechanism of intervertebral disc degeneration can be provided in this paper.

The aim of this study was to investigate to what extent annular fissures, vertebral and endplate changes, and Modic changes (MCs), coexist in low back pain (LBP) patients by using multiple imaging modalities. Sixty-two LBP patients (mean age 45 years, range 24–63, 53% men) were examined with same-day CT-discography and MRI. Intervertebral discs punctured for discography (n = 204) were evaluated on MRI [Pfirrmann grade, High-Intensity Zone (HIZ)] and on CT-discograms [Modified Dallas Discogram Score (DDS)]. DDS≥ 1, i.e., disc fissures involving the outer annulus were further digitomized into delimitable fissuring (<50% of annulus affected) or non-delimitable annular fissuring. Using both MRI and CT, adjacent vertebrae and endplates were assessed for MC, vertebral sclerosis, and a modified endplate defect score (EPS). In 194 discs the contrast agent was adequately injected during discography, of which 160 (83%) displayed outer annular fissures, with 91 (47%) of the latter being delimitable fissures. Most discs with delimitable fissures were moderately degenerated; 68% Pfirrmann grade ≤3, 71% EPS ≤ 2, and 12% displayed MC. The majority (76%) of MCs were associated with advanced adjacent disc degeneration; 84% Pfirrmann grade ≥4, 76% with non-delimitable annular fissuring, 59% EPS≥ 4, and 34% EPS of 3. A total 95 HIZ (47%) were found, of which 54 had delimitable fissuring, while the remainder displayed non-delimitable fissuring. Vertebral sclerosis was commonly observed (26%), both with MCs (73%) and without MCs (27%), and not specifically linked to MC type 3. A total of 97% of segments with vertebral sclerosis displayed outer annular fissures. These findings were significant (0.046 > p > 0.0001), except between HIZ and adjacent sclerosis (p = 0.303). To conclude, the present study confirmed a close interplay between the disc and adjacent vertebra and endplates. The fact that a majority of discs with delimitable annular fissures did not coexist with pronounced endplate changes and/or MCs, however, supports the theory that disc fissuring is an early event in the degenerative cascade. This was further supported by the fact that MCs were strongly linked to extensive disc fissuring and to advanced endplate damage. Further, vertebral sclerosis was common also in vertebra without MCs and strongly associated to annular fissuring, indicating that sclerosis is a previously underestimated feature of a general degenerative process. [ABSTRACT FROM AUTHOR]

Study Design. A descriptive, cross-sectional cadaver study. Objective. This study aimed to provide a thorough depiction of vertebral endplate defects classified based on their morphologic features and reported with respect to size, location, and prevalence in the human cadaveric spines of older adults. Summary of Background Data. Back pain has been associated with vertebral endplate defects; however, findings have been inconsistent. This is partially due to miscommunication surrounding the classification of endplate defects observed using clinical imaging, and limited knowledge of the types of defects present on the endplate and their prevalence. A comprehensive study of vertebral endplates is needed to clarify types of structural defects, their character, and prevalence. Materials and Methods. Using micro-computed tomography, 3-dimensional reconstructed images were created of 409 endplates from 19 cadaveric spines (9 men and 10 women; aged 62-91; T6-S1). Endplate defects were categorized based on their morphology, size, and location to investigate distribution patterns. Results. Seven types of endplate defects were identified: Schmorl nodes, corner fracture or limbus vertebra, other fractures, erosion, jagged surface, calcification, and depressions. Defects were identified on 63.6% of endplates. Multiple defects were present on 19.1% of endplates. Fracture and erosion were the most common defect types. Defects were more common on the endplate cranial to the intervertebral disc and in male specimens (P = 0.01). Defects were larger in the lumbar spine and the "total area of endplate defect" was larger on the cranial than the caudal endplate in the thoracic spine (P < 0.05). Conclusion. This is the first study of which we are aware that provides a thorough depiction of the morphology and distribution of endplate defects across the entire lower thoracic and lumbar spine (T6-S1) using micro-computed tomography. Results support the presence of several distinct endplate defect phenotypes with different prevalence rates and provide a reference when considering endplate defects in the elderly. [ABSTRACT FROM AUTHOR]

Study Design Cross-sectional comparative. Purpose To characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI). Overview of Literature Considering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported. Methods Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19–65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid–Schiff stain; examined for histological degeneration scores (HDS; 0–15), inflammation (0 [absence]–3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-gene-product 9.5 and expression was counted/mm2. Data was analyzed, and p

Modic changes (MC) have been proposed as a cause of low back pain (LBP). However, the proposition remains controversial. There is uncertainty over the existence or degree of association between the two and whether, if there is an association, it is a causal relationship. Previous systematic reviews of the evidence have had methodological flaws. The aim was to synthesize the current evidence to test the hypothesis that there is an association between MC and LBP and if there is, to evaluate the strength of the association. MEDLINE, EMBASE, and CINAHL were searched for all studies up to 31 December 2018 for cohort, case-control, and cross-sectional studies. Screening, quality assessment, and data extraction were conducted by two independent reviewers. Quality was assessed using the Joanna Biggs Institute tools for observational studies. The clinical heterogeneity among these studies ruled out pooling so a narrative review was undertaken. Fifteen studies met the inclusion criteria, varying in patient characteristics, characteristics of MC, coexisting spinal conditions, and outcomes. The quality of evidence was poor in six and moderate in seven. There was wide clinical heterogeneity amongst the studies. The inclusion ages varied from early teens to over 65s, pain duration varied from under 6 weeks to over three months, and characteristics of the MC chosen for the studies also differed. The results were inconsistent across the studies: the odds ratios varied from showing an inverse relationship [Kovacs] with an odds ratio 0.31 (95% confidence interval, 0.1–0.95) to a very strong positive association 121.4 (11.21–1315.08) [Nakamae]. There was no consistency in associations for: type of MC, lumbar levels affected, position in relation to the vertebra, and presence of co-existing spinal conditions. The associations were possibly spurious arising from potential biases suggested by incomplete reporting: publication bias, selective reporting, and post hoc analysis. Only one study at low risk of bias found a substantial association but it was a small study of a narrow group meaning its results may not be generalizable. The inconsistency of findings and the possibility that they were spurious means that no conclusions can be drawn about an association between MC and LBP. Future research should be designed as prospective cohort studies with adherence to reporting guidelines pertaining to observational studies and to MRI. Currently, clinicians should not look for the presence or absence of MC to guide their management of patients with LBP. [ABSTRACT FROM AUTHOR]

Study Design: Cross-sectional comparative. Purpose: To characterize the scores of disc degeneration, inflammation, and nerve density in herniated disc samples and associate findings with the presence of vertebral endplate (VEP) changes on magnetic resonance imaging (MRI). Overview of Literature: Considering the role of disc composition in spontaneous regression and persistence of pain during conservative management, it is important to identify the influencing factors. VEP changes are highly associated with disc degeneration, but their correlation with herniated disc composition has not yet been reported. Methods: Fifty-one discs were obtained from patients undergoing surgery for herniated disc. Their ages ranged from 19-65 years, and 31/51 were male. Pre-surgical T1 and T2 weighted lumbar-spine MRIs were analyzed to observe Pfirrmann grade, VEP defects, herniation type, Modic changes, and high-intensity zones (HIZ) at the affected level. Five-micron thick sections were stained with hematoxylin and eosin, Alcian blue periodic acid-Schiff stain; examined for histological degeneration scores (HDS; 0-15), inflammation (0 [absence]-3 [severe]), and presence of cartilaginous endplate (CEP). Three-micron thick sections were stained with protein-geneproduct 9.5 and expression was counted/mm2. Data was analyzed, and p <0.05 was considered to indicate statistical significance. Results: VEP defects, Modic changes, and HIZ were respectively observed in 30/51, 16/51, and 6/51 of the samples. CEP was observed in 26/51 samples and in 23/51 with endplate defects. Discs with adjacent VEP defects showed increased HDS (p <0.001) and inflammation (p <0.001). Discs with adjacent Modic changes also revealed increased HDS (p =0.01). Histological sections with CEP showed increased HDS (p <0.001) and inflammation (p <0.001), and nerve density was significantly positively correlated with HDS (r =0.27, p =0.02). Conclusions: VEP changes can modulate degeneration and inflammation of herniated discs. Presence of these changes is highly predictive of the occurrence of CEP in herniated discs, which leads to slow resorption and persistent clinical symptoms. [ABSTRACT FROM AUTHOR]

Adisa Kuršumović,1 Gerrit Joan Bouma,2 Larry E Miller,3 Richard Assaker,4 Erik Van de Kelft,5 Robert Hes,6 Jenny C Kienzler7 1Department of Neurosurgery, Donauisar Klinikum Deggendorf, Deggendorf, Germany; 2Department of Neurosurgery, OLVG-West and Academic Medical Center, Amsterdam, the Netherlands; 3Miller Scientific, Johnson City, TN, USA; 4Department of Neurosurgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France; 5Department of Neurosurgery, AZ Nikolaas, Sint-Niklaas and University of Antwerp, Antwerpen, Belgium; 6Department of Neurosurgery, AZ Klina, Brasschaat, Belgium; 7Department of Neurosurgery, Kantonsspital Aarau, Aarau, SwitzerlandCorrespondence: Adisa KuršumovićDepartment of Neurosurgery, Donauisar Klinikum Deggendorf, Deggendorf, GermanyEmail kursumovic@hotmail.comObjective: Vertebral endplate disruptions (VEPD) are common findings on imaging after lumbar surgery. The objective of this study was to explore the clinical implications of VEPD development following lumbar discectomy with or without implant with a bone-anchored annular closure device (ACD).Methods: This was a multicenter randomized controlled trial of patients with large postsurgical annular defects after limited lumbar discectomy who were randomized to additionally receive an ACD or no additional treatment. VEPD were identified on computed tomography and confirmed by an imaging core laboratory. Clinical outcomes included recurrent herniation, reoperation, Oswestry Disability Index, leg pain, and back pain. Patient follow-up in this study was 3 years.Results: In the ACD group (n=272), the risk of reoperation was lower in patients with vs without VEPD (8% vs 24%, p< 0.01), but no other clinical outcomes differed when stratified by VEPD prevalence or size. In the Control group (n=278), the risk of symptomatic reherniation was higher in patients with VEPD (41% vs 23%, p< 0.01) and patients with the largest VEPD had the highest reoperation rates. Patient-reported outcomes were not associated with VEPD prevalence or size in the Control group.Conclusion: VEPD had no significant influence on patient-reported outcomes at 3 years after lumbar discectomy. VEPD increased the risk of recurrence in patients treated with lumbar discectomy only, but had no negative influence in patients treated with the ACD.Keywords: annular closure, disc herniation, lumbar discectomy, randomized controlled trial, sciatica, vertebral endplate

BackgroundThe usefulness of routine follow-up Magnetic Resonance Imaging (MRI-2) in asymptomatic dogs treated for discospondylitis is unknown.MethodsThis cross-sectional retrospective study investigated the features of MRI-2 in a heterogeneous group of dogs treated for discospondylitis, and if these were associated with the presence or absence of clinical signs. After comparing initial MRI (MRI-1) and MRI-2, an observer, blinded to the dog's clinical signs, described the MRI-2 findings. The study population was then divided into symptomatic or asymptomatic at the time of MRI-2. Two separate observers subjectively classified the discospondylitis as active or inactive. Repeatability and interobserver agreement were evaluated.ResultsA total of 25 dogs were included. At the time of MRI-2 16 (64%) dogs were asymptomatic and 9 (36%) were symptomatic. Based on MRI-2, 20 (80%) and 18 (72%) out of 25 dogs were considered to have active discospondylitis by the first and second observers, respectively. Interobserver agreement was moderate. No MRI-2 features were associated with the clinical status. The subjective classification of inactive discospondylitis was significantly associated with asymptomatic clinical status, but the classification of active discospondylitis was evenly distributed between groups.ConclusionThis study did not identify a meaningful association between the clinical status of dogs treated for presumptive discospondylitis and MRI-2 results. There were no specific MRI-2 features which were associated with the clinical status.

Type 2 diabetes (T2D) adversely affects many tissues, and the greater incidence of discogenic low back pain among diabetic patients suggests that the intervertebral disc is affected too. Using a rat model of polygenic obese T2D, we demonstrate that diabetes compromises several aspects of disc composition, matrix homeostasis, and biomechanical behavior. Coccygeal motion segments were harvested from 6-month-old lean Sprague-Dawley rats, obese Sprague-Dawley rats, and diabetic obese UCD-T2DM rats (diabetic for 69 ± 7 days). Findings indicated that diabetes but not obesity reduced disc glycosaminoglycan and water contents, and these degenerative changes correlated with increased vertebral endplate thickness and decreased endplate porosity, and with higher levels of the advanced glycation end-product (AGE) pentosidine. Consistent with their diminished glycosaminoglycan and water contents and their higher AGE levels, discs from diabetic rats were stiffer and exhibited less creep when compressed. At the matrix level, elevated expression of hypoxia-inducible genes and catabolic markers in the discs from diabetic rats coincided with increased oxidative stress and greater interactions between AGEs and one of their receptors (RAGE). Taken together, these findings indicate that endplate sclerosis, increased oxidative stress, and AGE/RAGE-mediated interactions could be important factors for explaining the greater incidence of disc pathology in T2D.

Abstract Background Although deformation and fracture of the vertebral endplate have been implicated in spinal conditions such as vertebral fracture and disc degeneration, few biomechanical studies of this structure are available. The goal of this study was to quantify the mechanical behavior of the vertebral endplate. Methods Eight‐five rectangular specimens were dissected from the superior and/or inferior central endplates of human lumbar spine segments L1 to L4. Micro‐computed tomography (μCT) imaging, four‐point‐bend testing, and ashing were performed to quantify the apparent elastic modulus and yield stress (modulus and yield stress, respectively, of the porous vertebral endplate), tissue yield stress (yield stress of the tissue of the vertebral endplate, excluding pores), ultimate strain, fracture strain, bone volume fraction (BV/TV), bone mineral density (BMD), and various measures of tissue density and composition (tissue mineral density, ash fraction, and ash density). Regression was used to assess the dependence of mechanical properties on density and composition. Results Wide variations in elastic and failure properties, and in density and tissue composition, were observed. BMD and BV/TV were good predictors of many of the apparent‐level mechanical properties, including modulus, yield stress, and in the case of the inferior vertebral endplate, failure strains. Similar values of the mechanical properties were noted between superior and inferior vertebral endplates. In contrast to the dependence of apparent stiffness and strength on BMD and BV/TV, none of the mechanical properties depended on any of the tissue‐level density measurements. Conclusion The dependence of many of the mechanical properties of the vertebral endplate on BV/TV and BMD suggests possibilities for noninvasive assessment of how this region of the spine behaves during habitual and injurious loading. Further study of the nonmineral components of the endplate tissue is required to understand how the composition of this tissue may influence the overall mechanical behavior of the vertebral endplate.

Background: Although deformation and fracture of the vertebral endplate have been implicated in spinal conditions such as vertebral fracture and disc degeneration, few biomechanical studies of this structure are available. The goal of this study was to quantify the mechanical behavior of the vertebral endplate. Methods: Eight‐five rectangular specimens were dissected from the superior and/or inferior central endplates of human lumbar spine segments L1 to L4. Micro‐computed tomography (μCT) imaging, four‐point‐bend testing, and ashing were performed to quantify the apparent elastic modulus and yield stress (modulus and yield stress, respectively, of the porous vertebral endplate), tissue yield stress (yield stress of the tissue of the vertebral endplate, excluding pores), ultimate strain, fracture strain, bone volume fraction (BV/TV), bone mineral density (BMD), and various measures of tissue density and composition (tissue mineral density, ash fraction, and ash density). Regression was used to assess the dependence of mechanical properties on density and composition. Results: Wide variations in elastic and failure properties, and in density and tissue composition, were observed. BMD and BV/TV were good predictors of many of the apparent‐level mechanical properties, including modulus, yield stress, and in the case of the inferior vertebral endplate, failure strains. Similar values of the mechanical properties were noted between superior and inferior vertebral endplates. In contrast to the dependence of apparent stiffness and strength on BMD and BV/TV, none of the mechanical properties depended on any of the tissue‐level density measurements. Conclusion: The dependence of many of the mechanical properties of the vertebral endplate on BV/TV and BMD suggests possibilities for noninvasive assessment of how this region of the spine behaves during habitual and injurious loading. Further study of the nonmineral components of the endplate tissue is required to understand how the composition of this tissue may influence the overall mechanical behavior of the vertebral endplate. [ABSTRACT FROM AUTHOR]

Abstract Though segmentation of spinal column from medical images have been intensively studied for decade, most of the works were concentrated on the segmentation of the vertebral body and arch, instead of the endplate. Recently, the increasing study on degeneration analysis of vertebra and intervertebral disc (IVD) make endplate segmentation as important as others. While the accurately segmentation of mice endplate from micro computed tomography (CT) images is challenging. The major difficulties include potential high system payload and poor run-time efficiency resulting from high-resolution micro-CT data, highly complicated and variable shape of the vertebra tissues, and the ambiguous segmentation boundary due to the similarity of spongy structures inside both the endplate and its adjacent vertebral body. To solve the problems, the core idea of the proposed method is to identify trabeculae between the endplate and the body through a graph-based strategy. In addition, in order to reduce the data complexity, an endplate-targeted region of interest (ROI) extraction method is introduced according to the analysis of spatial relationship and variety of bone density of vertebra. Furthermore, shape priori of endplate in both two-dimensional and three-dimensional are extracted to assist in the segmentation. Finally, an iterative cutting procedure is implemented to produce the final result. Experiments were carried out which validate the performances of the proposed method in terms of effectiveness and accuracy.

The article presents a literature review on the Modic changes (MCs) in the vertebral endplates, which are frequently detected in patients with chronic low back pain. The etiology of MCs is unknown; however, there are three causes which are considered the most probable today: mechanical, infectious and biochemical. They share a common mechanism of pro-inflammatory molecule migration from the degenerative disk. A close association has been identified and described between the MCs and a non-specific chronic low back pain. Disc degeneration exerts a further stress on the endplates and produces microcracks, through which the inflammatory mediators enter the bone marrow and provoke the MCs. At present, there are no evidence-based treatment protocols for the MCs. A certain progress has been made with antibiotic therapy, injections of steroids and antiresorbents; the effectiveness of anti-TNF-α therapy is being explored. The sporadic reference data on our disposal indicate that patients with MCs and chronic low back pain, along with instability, who do not respond to a conservative treatment, may be referred for the surgical treatment to relieve pain and improve quality of life. However, not all of the presented methods of surgical treatment with chronic back pain are effective in patients with the Modic changes. The divergence of patient treatment outcomes presented by various sources indicates the need for a further research to understand the MC pathogenesis and develop pathogenetic approaches to the treatment of this pathology. [ABSTRACT FROM AUTHOR]

Study Design: An ex vivo study of the rabbit's vertebral endplate.Objective: The aim of this study was to assess the effect of axial compression and distraction on vascular buds and vascular endothelial growth factor (VEGFA) expression of the vertebral endplate (VEP).Summary Of Background Data: The abnormal load can lead to intervertebral disc degeneration (IDD), whereas axial distraction can delay this process. The effects of different mechanical loads on the intervertebral disc (IVD) have been hypothesized to be related to changes in the vascular buds of the VEP; moreover, the process that might involve the vascular endothelial growth factor (VEGF) within the VEP.Methods: Rabbit spinal segments (n = 40) were harvested and randomly classified into four groups: Control group, no stress was applied; Group A, a constant compressive load applied; Group B, compression load removed for a fixed time daily on a continuous basis, and substituted with a distraction load for 30 minutes; and Group C, compression removed for 30 minutes for a fixed period daily on a continuous basis. Tissue specimens were collected before the culture (day 0) and on day 14 post-culture of each group for analysis of IVDs' morphology, and protein and mRNA expression of Aggrecan, COL2al, VEGFA, and vascular endothelial growth factor receptor 2 of the VEPs.Results: Application of axial distraction and dynamic load compression significantly delayed time- and constant compression-mediated VEP changes and IDD. Moreover, the degree of degeneration was associated with loss of vascular buds, as well as the downregulation of VEGFA and its receptor.Conclusion: The regulation of vascular buds and VEGF expression in the VEP represents one of the mechanisms of axial distraction and dynamic loading.Level of Evidence: N/A. [ABSTRACT FROM AUTHOR]

BackgroundIn this preliminary study we used a goat model to quantify pressure at an interbody bone graft interface. Although the study was designed to assess fusion status, the concept behind the technology could lead to early detection of implant failure and potential hazardous complications related to motion-preservation devices. The purpose of this study was to investigate the feasibility of in vivo pressure monitoring as a strategy to determine fusion status.MethodsTelemetric pressure transducers were implanted, and pressure at the bone graft interfaces of cervical interbody fusion autografts placed into living goats (Groups A and B) was evaluated. Group A constituted the 4-month survival group and Group B the 6-month survival group. One goat served as the study control (Group C) and was not implanted with a pressure transducer. An additional six cadaveric goat cervical spines (Group D) were obtained from a local slaughterhouse and implanted with bone grafts and ventral plates and used for in vitro biomechanical comparison to the specimens from Groups A and B.ResultsAll goats demonstrated an increase in interface pressure within the first 10 days postoperatively, with the largest relative change in pressure occurring between the sixth and ninth days. The goats from Groups A and B had a 200% to 400% increase in relative pressure.ConclusionsAlthough this was a pilot study to assess pressure as an indicator for a fusion or pseudarthrosis, the preliminary data suggest that early bone healing is detectable by an increase in pressure. Thus, pressure may serve as an indicator of fusion status by detecting altered biomechanical parameters.

The endplate (EP) is a composite structure made of osseous and cartilage components that separates the intervertebral disc from the vertebral body. As an intermediary link between rigid bone tissue and the flexible intervertebral disc, EP is affected by structural changes as well as changes in biomechanical properties of both these elements caused by pathological changes in the spine. One of the modern civilization hazards related to the skeletal system are osteoporotic changes. Although the influence of osteoporosis on vertebral bodies has been extensively researched, there is still a lack of information about its impact on the structure of the endplate itself. The aim of this study was to carry out a quantitative and qualitative assessment of the impact of osteoporosis on individual layers of EP. An animal model of the cervical and thoracic vertebrae was used. The analyses were conducted on two study groups: control (healthy sheep) and osteoporotic (with induced osteoporosis). Microstructural changes were analyzed using a micro-CT scanner, while mechanical parameters were analyzed using the microindentation test. There were no statistically significant differences in the analyzed parameters between cranial and caudal endplates. The performed tests showed significant changes in the trabecular microarchitecture of the endplate layer caused by osteoporosis. Despite the presence of morphometric changes in the osteoporotic group, no significant changes were observed in the mechanical properties of analyzed structures. A comparison of the mechanical parameters obtained for healthy endplates of the sheep model showed a high correlation with literature data for the human model. [ABSTRACT FROM AUTHOR]

In the artificial cervical disc replacement (ACDR), the polishing quality of fitting surface between vertebral endplate and artificial intervertebral disc has a direct relation with operation result. For this reason, an in-depth study is necessary on the vertebral endplate cutting process. This paper is intended to simulate and analyze the cutting process of vertebral endplate using numerical computation method. Firstly, a plane cutting model is established through an analysis on the cutting process to simulate the single-edge cutting process, and the temperature distribution calculation is carried out using the mean heat flux of continuous cutting. Secondly, a vertebral endplate material constitutive model is established on the basis of the endplate anatomy and mechanical property, so that some problems are analyzed about simulation algorithm, frictional contact and chip separation in the vertebral endplate cutting finite element (FE) simulation. Finally, stress distribution, cutting force, endplate deformation and residual stress and cutting temperature, as well as simulation results, are analyzed in vertebral endplate cutting process. The FE simulation may simplify vertebral endplate cutting, improve analytical precision, avoid plenty of repetitive cutting experiments, and reduce research cost greatly. Moreover, it gives full and fine description to the whole continuous, dynamic cutting process. All of this lay solid theoretical basis for an in-depth study of influence of different cutting parameters on endplate cutting as well as improvement of operation effect.

Study Design: Retrospective image-based analysis.Objective: To measure endplate three-dimensional (3D) geometry, endplate changes in vivo and to investigate correlations between disc degeneration and endplate 3D geometry dependent on symptoms of low back pain (LBP).Summary Of Background Data: It has been hypothesized that alteration of load transmission from the nucleus pulposus to the annulus fibrosus affects vertebral endplate geometry.Methods: 3D surface models of inferior/superior lumbar endplates were created from computed tomography scans of n = 92 volunteers with and without LBP. Disc degeneration was evaluated using Pfirrmann scale. Concavity in both coronal and sagittal planes was assessed with the Concavity Index (unitless; larger than 1: concave; flat: 1; and less than 1: convex, respectively). Endplate area and disc height distribution were computed and the effects from demographics and spinal degeneration were sought with an analysis of variance model.Results: Both sagittal and coronal planes revealed significantly decreased concavity in those with terminal grade 5 disc degeneration (mean 0.833 ± 0.235) compared to the other grades in the cohort. Older subjects presented with larger endplate areas than the younger subjects (P = 0.0148) at L4-S1. Overall, symptomatic subjects had significantly larger endplate areas (P = 0.022), especially at the lower lumbar levels (P < 0.001). Analysis of variance showed that sex, disc level, disc degeneration grade, and disc height reached significance (P < 0.0001) as influential parameters in both Concavity Index cases.Conclusion: With advancing intervertebral disc degeneration, endplates become more convex over time in both sagittal and coronal planes. Our findings implicate the endplate changes with advancing disc degeneration in the shift in load transmission from the nucleus pulposus to the annulus fibrosus, resulting in changes within the curvature of the endplates. This is also the first study to describe the direct impact of age, sex, and LBP on vertebral endplate anatomy.Level Of Evidence: 5. [ABSTRACT FROM AUTHOR]

Degenerative disc disease is a progressive, chronic disorder with strong association to pain, where the dysregulated tissue environment signals disc cells, thereby leading to a low inflammatory process and slow extracellular matrix degradation and fibrosis in a perpetual vicious cycle, generating a structural and functional failure of intervertebral disc joint (IVDJ). Among current biologic therapies, there is an emerging minimally invasive strategy that consists of infiltrating plasma rich in growth factors, a safe and efficacious therapeutic approach for other musculoskeletal degenerative conditions. This review summarizes the homeostasis and degeneration of IVDJ, discusses some results on basic science and therapeutic use of platelet-rich plasma products and advances an alternative minimally invasive biologic therapy in IVDJ degeneration and chronic back pain. [ABSTRACT FROM AUTHOR]

Study Design: A family-based study.Objective: The aim of this study was to identify rare genetic factors predisposing to Modic changes (MCs).Summary Of Background Data: Lumbar disc degeneration (LDD) is one of the contributing factors behind low back pain (LBP). Lumbar MC visualized as bone marrow signal intensity changes on magnetic resonance imaging (MRI) represent a specific phenotype of LDD, which has a stronger association with LBP than LDD without MC.Methods: The study set consisted of two Finnish families: Family I included seven affected and four unaffected individuals and Family II eight affected and seven unaffected individuals. MCs were evaluated in 26 individuals using MRI. Whole exome sequencing was used to identify alleles cosegregating with MC. Annotate variation was used to carry out functional annotation of alleles and their frequencies were evaluated using 1000Genomes, Sequencing Initiative Suomi (SISu), and the Exome Aggregation Consortium (ExAC) databases.Results: We identified predisposing genetic alleles for MC in two Finnish families. In each family, only single allele cosegregated with MC. In Family I, the observed allele was an insertion and deletion in the HSPG2 gene, resulting in a premature termination codon. In Family II, a single nucleotide polymorphism (rs61753465) in the MAML1 gene was identified in all affected family members.Conclusion: We have identified two novel candidate genes, MAML1 and HSPG2, associating with MC. These genes are important in cartilage structure and joint cartilage maintenance. Our findings are novel among lumbar spine degenerative phenotypes.Level Of Evidence: N/A. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to evaluate the association between vertebral endplate morphology and the degree of lumbar intervertebral disc degeneration via magnetic resonance imaging (MRI). Methods In total, 150 patients who met the inclusion criteria and were 20–60 years of age were retrospectively evaluated. Patients were evaluated for the presence of intervertebral disc degeneration or herniation, and the degree of degeneration was assessed at all lumbar levels. Vertebral endplate morphology was evaluated based on the endplate sagittal diameter, endplate sagittal concave angle (ECA), and endplate sagittal concave depth (ECD) on sagittal MRI. The association between intervertebral disc degeneration or herniation and endplate morphological measurements was analysed. Results In MRI, superior endplates ( ie , inferior endplates of the superior vertebra) were concave and inferior endplates ( ie , superior endplates of the inferior vertebra) were flat at all disc levels. A decrease in ECD and an increase in ECA were detected at all lumbar levels as disc degeneration increased ( P < .05). At the L4-L5 and L5-S1 levels, a decrease in ECD and an increase in ECA were detected in the group with herniated lumbar discs ( P < .05). There was no association between lumbar disc degeneration or herniation and endplate sagittal diameter at lumbar intervertebral levels ( P > .05). At all levels, ECD of women was significantly lesser than that of men and ECA of women was significantly greater than that of men ( P < .05). Conclusions There is an association between vertebral endplate morphology and lumbar intervertebral disc degeneration. Vertebral endplates at the degenerated disc level become flat; the severity of this flattening is correlated with the degree of disc degeneration. [ABSTRACT FROM AUTHOR]