The roles of vertebra and vertebral endplate in lumbar disc degeneration

  • Author / Creator
    Wang, Yue
  • 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.

  • Subjects / Keywords
  • Graduation date
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
  • Language
  • Institution
    University of Alberta
  • Degree level
  • Department
    • Faculty of Rehabilitation Medicine
  • Supervisor / co-supervisor and their department(s)
    • Michele Crites Battié, Department of Physical Therapy, Faculty of Rehabilitation Medicine
  • Examining committee members and their departments
    • Steve Boyd, Schulich School of Engineering, University of Calgary
    • Tapio Videman, Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta
    • Yutaka Yasui, School of Public Health, University of Alberta
    • Gunnar B.J. Andersson, Department of Orthopedic Surgery, Rush University Medical Center