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The roles of vertebra and vertebral endplate in lumbar disc degeneration Open Access


Other title
lumbar spine
Schmorl's nodes
back pain
bone mineral density
disc degeneration
Type of item
Degree grantor
University of Alberta
Author or creator
Wang, Yue
Supervisor and department
Michele Crites Battié, Department of Physical Therapy, Faculty of Rehabilitation Medicine
Examining committee member and department
Gunnar B.J. Andersson, Department of Orthopedic Surgery, Rush University Medical Center
Tapio Videman, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta
Yutaka Yasui, School of Public Health, University of Alberta
Steve Boyd, Schulich School of Engineering, University of Calgary
Faculty of Rehabilitation Medicine

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Background The adjacent vertebrae and endplates are important to maintaining the integrity and functions of the intervertebral disc. Yet, they have received relatively little attention and their roles in disc degeneration (DD) and back pain remain unclear. Purpose The purpose of this doctoral research was to describe the morphometrics of the lumbar vertebral endplate, characterise endplate lesions, and explore the roles of morphological and pathological findings of the adjacent vertebrae and vertebral endplates in the pathogenesis of DD. Materials and Methods Studies were extended from a cadaveric lumbar spine archive of 157 Caucasian men (mean age 51.2 years). Using discography, DD was rated as absent, slight, moderate or severe. A sample of 150 vertebrae was scanned with micro-CT to explore the relationship between vertebral bone mineral density (BMD) and DD, BMD and thickness of the vertebral endplate and DD. Using a laser digitizer, morphological measurements of 591 vertebral endplates were quantified to determine their associations with DD. In addition, a total of 1148 vertebral endplates were visually examined to determine the prevalence rate, pathological classification, and distribution patterns of lumbar endplate lesions, as well as their associations with age, DD and back pain history. Results and Conclusions Higher BMD of the vertebral body, but not that of the whole vertebra, was associated with more severe adjacent DD. Among the endplate morphological measurements measured, including size, thickness, circularity, concavity and BMD, only greater endplate thickness and size were found to associate with more DD. Yet, the associations observed were relatively weak, suggesting a modest role of endplate morphometrics in DD. In contrast, endplate lesions were common findings in the lumbar spine of mid-aged men and were strongly associated with DD. Furthermore, four types of endplate lesions were identified, including Schmorl’s nodes, fracture, erosion and calcification. These lesions had distinct morphological features, different distribution patterns and varying degrees of association with adjacent DD. Lumbar endplate lesions tended to affect both adjacent endplates of a disc together and appear to play an important role in DD. Findings also suggest endplate lesions may be a source of back pain.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Wang, Y, Boyd, S; Videman, T; Yasui, Y; Battié, MC. Is Greater Lumbar Vertebral Bone Mineral Density Associated With More Disc Degeneration? A Study Using Micro-CT and Discography. The Journal of Bone and Mineral Research. 2011 Nov;26(11):2785-91.Wang Y, Battié MC, Boyd SK, Videman T. The Osseous Endplates in Lumbar Vertebra: Thickness, Bone Mineral Density and Their Associations with Disk Degeneration. Bone, 2011 Apr 1;48(4):804-9.

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