Sabrina Munir1, Maxim B Freidin1, Marinko Rade2,3, Juhani Määttä1,4, Gregory Livshits1,5, Frances M K Williams1. 1. Department of Twin Research, King's College London, London, UK. 2. Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, Kuopio, Finland. 3. Faculty of Medicine, Orthopaedic and Rehabilitation Hospital "Prim. dr.Martin Horvat", Josip Juraj Strossmayer University of Osijek, Rovinj, Croatia. 4. Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland. 5. Department of Anatomy, Tel Aviv University, Tel Aviv, Israel.
Abstract
STUDY DESIGN: Longitudinal study of spine magnetic resonance imaging (MRI) in a large-scale population-based study. OBJECTIVE: To determine the order of appearance of degenerative change in vertebral bodies and intervertebral discs. We also sought to define the influence of endplate defect on low back pain (LBP) and to determine whether there is a genetic influence on endplate defect. SUMMARY OF BACKGROUND DATA: Endplate defect is a magnetic resonance imaging trait, found to be associated with intervertebral disc degeneration. There is a lack of understanding regarding the mechanism underlying lumbar disc degeneration (LDD). Recent attention has shifted to vertebral endplate defects and their role in spine degeneration pathology. METHODS: Individuals from the TwinsUK spine study having longitudinal T2-weighted lumbar MR scans at baseline (n = 996) and a decade later (n = 438) were included. LDD, vertebral endplate defect by calculating a total endplate score, and Modic change (MC) were assessed using standard techniques. Mixed-effects models were used to determine the association between the features of spine pathology, adjusted for covariates. Endplate defect heritability was estimated using variance component analysis. RESULTS: Significant association was found between endplate defect, LDD, MRI features of LDD and MC was observed. Endplate defect was associated with severe disabling LBP (P ≤ 0.013) in multivariate analysis. An association between disc degeneration (DD) at baseline and MC at follow-up was shown at upper lumbar levels. Total endplate score was heritable with estimated additive genetic component A = 55.3% (95% CI 43.0-65.4). CONCLUSION: Endplate defect, LDD, and MC are all independent risk factors for episodes of severe and disabling LBP. Longitudinal analysis showed DD is followed by MC. Endplate defect has significant heritability of 55%. However, whether endplate defect triggers DD or these pathological changes occur concurrently could not be conclusively determined. LEVEL OF EVIDENCE: 2.
STUDY DESIGN: Longitudinal study of spine magnetic resonance imaging (MRI) in a large-scale population-based study. OBJECTIVE: To determine the order of appearance of degenerative change in vertebral bodies and intervertebral discs. We also sought to define the influence of endplate defect on low back pain (LBP) and to determine whether there is a genetic influence on endplate defect. SUMMARY OF BACKGROUND DATA: Endplate defect is a magnetic resonance imaging trait, found to be associated with intervertebral disc degeneration. There is a lack of understanding regarding the mechanism underlying lumbar disc degeneration (LDD). Recent attention has shifted to vertebral endplate defects and their role in spine degeneration pathology. METHODS: Individuals from the TwinsUK spine study having longitudinal T2-weighted lumbar MR scans at baseline (n = 996) and a decade later (n = 438) were included. LDD, vertebral endplate defect by calculating a total endplate score, and Modic change (MC) were assessed using standard techniques. Mixed-effects models were used to determine the association between the features of spine pathology, adjusted for covariates. Endplate defect heritability was estimated using variance component analysis. RESULTS: Significant association was found between endplate defect, LDD, MRI features of LDD and MC was observed. Endplate defect was associated with severe disabling LBP (P ≤ 0.013) in multivariate analysis. An association between disc degeneration (DD) at baseline and MC at follow-up was shown at upper lumbar levels. Total endplate score was heritable with estimated additive genetic component A = 55.3% (95% CI 43.0-65.4). CONCLUSION: Endplate defect, LDD, and MC are all independent risk factors for episodes of severe and disabling LBP. Longitudinal analysis showed DD is followed by MC. Endplate defect has significant heritability of 55%. However, whether endplate defect triggers DD or these pathological changes occur concurrently could not be conclusively determined. LEVEL OF EVIDENCE: 2.
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