The vertebral endplate: disc degeneration, disc regeneration

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.

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Prevalence, Patterns, and Genetic Association Analysis of Modic Vertebral Endplate Changes

Asian Spine Journal ◽

10.4184/asj.2017.11.4.594 ◽

2017 ◽

Vol 11 (4) ◽

pp. 594-600 ◽

Cited By ~ 9

Author(s):

Rishi Mugesh Kanna ◽

Rajasekaran Shanmuganathan ◽

Veera Ranjani Rajagopalan ◽

Senthil Natesan ◽

Raveendran Muthuraja ◽

...

Keyword(s):

Candidate Genes ◽

Genetic Association ◽

Association Analysis ◽

Disc Degeneration ◽

Lumbar Disc ◽

Nucleotide Polymorphisms ◽

Lumbar Disc Degeneration ◽

Vertebral Endplate ◽

Genetic Association Analysis ◽

Study Population

<sec><title>Study Design</title>A prospective genetic association study.</sec><sec><title>Purpose</title>The etiology of Modic changes (MCs) is unclear. Recently, the role of genetic factors in the etiology of MCs has been evaluated. However, studies with a larger patient subset are lacking, and candidate genes involved in other disc degeneration phenotypes have not been evaluated. We studied the prevalence of MCs and genetic association of 41 candidate genes in a large Indian cohort.</sec><sec><title>Overview of Literature</title>MCs are vertebral endplate signal changes predominantly observed in the lumbar spine. A significant association between MCs and lumbar disc degeneration and nonspecific low back pain has been described, with the etiopathogenesis implicating various mechanical, infective, and biochemical factors.</sec><sec><title>Methods</title>We studied 809 patients using 1.5-T magnetic resonance imaging to determine the prevalence, patterns, distribution, and type of lumbar MCs. Genetic association analysis of 71 single nucleotide polymorphisms (SNPs) of 41 candidate genes was performed based on the presence or absence of MCs. SNPs were genotyped using the Sequenome platform, and an association test was performed using PLINK software.</sec><sec><title>Results</title>The mean age of the study population (n=809) was 36.7±10.8 years. Based on the presence of MCs, the cohort was divided into 702 controls and 107 cases (prevalence, 13%). MCs were more commonly present in the lower (149/251, 59.4%) than in the upper (102/251, 40.6%) endplates. L4–5 endplates were the most commonly affected levels (30.7%). Type 2 MCs were the most commonly observed pattern (n=206, 82%). The rs2228570 SNP of VDR (<italic>p</italic>=0.02) and rs17099008 SNP of MMP20 (<italic>p</italic>=0.03) were significantly associated with MCs.</sec><sec><title>Conclusions</title>Genetic polymorphisms of SNPs of VDR and MMP20 were significantly associated with MCs. Understanding the etiopathogenetic mechanisms of MCs is important for planning preventive and therapeutic strategies.</sec>

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10. Embryonic Stem Cells Used for Disc Regeneration in an In Vivo Model of Disc Degeneration

The Spine Journal ◽

10.1016/j.spinee.2008.06.012 ◽

2008 ◽

Vol 8 (5) ◽

pp. 5S ◽

Cited By ~ 1

Author(s):

Ramiro Perez De La Torre ◽

Hormoz Sheikh ◽

Mick Perez-Cruet ◽

Chistopher Fecek ◽

Rasul Chaudhry ◽

...

Keyword(s):

Stem Cells ◽

Embryonic Stem Cells ◽

Disc Degeneration ◽

Embryonic Stem ◽

In Vivo Model ◽

Disc Regeneration

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Cervical Disc Degeneration and Vertebral Endplate Defects After the Fused Operation

Spine ◽

10.1097/brs.0000000000004007 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Olga Leonova ◽

Evgenii Baykov ◽

Abdugafur Sanginov ◽

Aleksandr Krutko

Keyword(s):

Disc Degeneration ◽

Cervical Disc ◽

Vertebral Endplate

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Lumbar disc rehydration postimplantation of a posterior dynamic stabilization system

Journal of Neurosurgery Spine ◽

10.3171/2010.5.spine08418 ◽

2010 ◽

Vol 13 (5) ◽

pp. 576-580 ◽

Cited By ~ 14

Author(s):

Bo Young Cho ◽

Judith Murovic ◽

Kyung Woo Park ◽

Jon Park

Keyword(s):

Disc Degeneration ◽

Lumbar Disc ◽

Young Male ◽

Dynamic Stabilization ◽

Disc Height ◽

Physiological Status ◽

Disc Regeneration ◽

Intervertebral Disc Regeneration ◽

Mechanical Approach ◽

Posterior Dynamic Stabilization

Biological attempts at disc regeneration are promising; however, disc degeneration is closely related to other predisposing factors such as alteration of disc height, intradiscal pressure, load distribution, and motion. The restoration of the physiological status of the affected spinal segment is thus necessary prior to attempts at disc regeneration. Dynamic stabilization systems now offer the potential of a mechanical approach to intervertebral disc regeneration.The authors used decompression and placement of the BioFlex dynamic stabilization device to treat a young male patient with disc degeneration. This patient underwent follow-up, and he was found to gradually improve both neurologically and radiographically. On MR imaging performed 1 year postoperatively, he had an increase in disc height and disc rehydration. This case and the concept of disc rehydration are presented in this paper.

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Reactive changes in the adolescent porcine spine with disc degeneration due to endplate injury

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0037-1616581 ◽

2007 ◽

Vol 20 (01) ◽

pp. 12-17 ◽

Cited By ~ 11

Author(s):

A. Baranto ◽

A. Kaigle Holm ◽

L. Ekström ◽

L. Swärd ◽

T. Hansson ◽

...

Keyword(s):

Blood Vessels ◽

Nucleus Pulposus ◽

Disc Degeneration ◽

Annulus Fibrosus ◽

Scar Tissue ◽

Vertebral Endplate ◽

Lumbar Intervertebral Disc ◽

Physiological Loading ◽

Reactive Changes ◽

Chronic Inflammatory Reaction

SummaryDegenerative and reactive structural alterations occurring after experimentally-induced disc degeneration were evaluated using a porcine model. A cranial perforation was made through the L4 vertebral endplate into the nucleus pulposus. Three months later, the lumbar intervertebral disc and adjacent vertebrae were dissected, fixed in formalin and further processed for histopathological analyses. The results showed that there were nucleus pulposus fragments, rather than a distinct border between the nucleus and annulus fibrosus. The central lamellae were distorted and delamination of the outer anterior layers was observed. Blood vessels emerged from the adjacent tissue, penetrated the annulus and branched into the residues of the nucleus. Nerve fibres accompanying the blood vessels could be recognized in the disc within the connective scar tissue. The epiphyseal cartilage plates in the vertebrae were hypertrophic in several areas and there was bone formation directed towards the centre of the vertebral body and the disc. Hypertrophic hyaline cartilage, newly formed bone and scar tissue filled the injury canal. A slight chronic inflammatory reaction was evident along vascular buds. The reactive changes dominated over the degenerated features in the operated disc. Physiological loading enhanced the infiltration of various tissue types characterizing immature cartilage formation. Prominent neovascularisation of the central parts of the disc is likely to be of key importance in turning the degenerative features of the remaining tissue into reactive healthy structures.

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Transplantation of mesenchymal stem cells and nucleus pulposus cells in a degenerative disc model in rabbits: a comparison of 2 cell types as potential candidates for disc regeneration

Journal of Neurosurgery Spine ◽

10.3171/2010.11.spine10285 ◽

2011 ◽

Vol 14 (3) ◽

pp. 322-329 ◽

Cited By ~ 59

Author(s):

Ganjun Feng ◽

Xianfeng Zhao ◽

Hao Liu ◽

Huina Zhang ◽

Xiangjun Chen ◽

...

Keyword(s):

Gene Expression ◽

Stem Cells ◽

Mesenchymal Stem Cells ◽

Nucleus Pulposus ◽

Disc Degeneration ◽

Signal Intensity ◽

Disc Height ◽

Nucleus Pulposus Cells ◽

Disc Regeneration ◽

Disc Model

Object The aim of this study was to compare transplanted mesenchymal stem cells (MSCs) with nucleus pulposus cells (NPCs) in a degenerative disc model in rabbits to determine the better candidate for disc cell therapy. Methods Mesenchymal stem cells and NPCs were transplanted in a rabbit model of disc degeneration. Changes in disc height, according to plain radiography, T2-weighted signal intensity on MR imaging, histology, sulfated glycosaminoglycan (sGAG)/DNA, and associated gene expression levels, were evaluated among healthy controls without surgery, sham-operated animals in which only disc degeneration was induced, MSC-transplanted animals, and NPC-transplanted animals for a 16-week period. Results Sixteen weeks after cell transplantation, in the MSC- and NPC-transplanted groups, the decline in the disc height index was reduced and T2-weighted signal intensity increased compared with the sham-operated group. Safranin O staining showed a high GAG content, which was also supported by sGAG/DNA assessment. Disc regeneration was also confirmed at the gene expression level using real-time polymerase chain reaction. However, no significant differences in expression were found between the NPC- and MSC-transplanted groups. Conclusions Study data showed that MSC transplantation is effective for the treatment of disc degeneration and seems to be an ideal substitute for NPCs.

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