Weishaupt D, Zanetti M, Hodler J, et al. Painful Lumbar Disk Derangement: Relevance of Endplate Abnormalities at MR Imaging

Departments of Radiology, Orthopaedic University Hospital Balgrist, Zurich, Switzerland.
Radiology (Impact Factor: 6.87). 03/2001; 218(2):420-7. DOI: 10.1148/radiology.218.2.r01fe15420
Source: PubMed


To investigate the predictive value of magnetic resonance (MR) imaging of abnormalities of the lumbar intervertebral disks, particularly with adjacent endplate changes, to predict symptomatic disk derangement, with discography as the standard.
Fifty patients aged 28-50 years with chronic low back pain and without radicular leg pain underwent prospective clinical examination and sagittal T1- and T2-weighted and transverse T2-weighted MR imaging. Subsequently, patients underwent lumbar discography with a pain provocation test (116 disks). MR images were evaluated for disk degeneration, a high-signal-intensity zone, and endplate abnormalities. Results of pain provocation at discography were rated independently of the image findings as concordant or as nonconcordant or painless. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess the clinical relevance of MR abnormalities.
Normal disks on MR images were generally not painful at provocative discography (NPV, 98%). Disk degeneration (sensitivity, 98%; specificity, 59%; PPV, 63%) and a high-signal-intensity zone (sensitivity, 27%; specificity, 85%; PPV, 56%) were not helpful in the identification of symptomatic disk derangement. When only moderate and severe type I and type II endplate abnormalities were considered abnormal, all injected disks caused concordant pain with provocation (sensitivity, 38%; specificity, 100%; PPV, 100%).
Moderate and severe endplate abnormalities appear be useful in the prediction of painful disk derangement in patients with symptomatic low back pain.

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    • "La dégénérescence discale regroupe initialement la perte de hauteur discale, l'hyposignal T2 et le bombement discal. Si leur valeur prédictive négative de la dégénérescence discale est forte (98 %), signifiant que son absence rend peu probable la présence d'une douleur d'origine discale, leur VPP et leur spécificité restent modestes même en utilisant les grades 3 et 4 de la classification de Pfirrmann [27]. Hancock et al. rapportent des rapports de vraisemblance positifs mais peu élevés à partir du grade 3 de Pfirrmann (entre 2,8 et 5,7) et restant bien inférieur à celle du Modic 1 [58]. "
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    03/2014; 96. DOI:10.1016/j.jradio.2013.11.015
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    • "The prevalence of VESC varies greatly among studies ranging from less than 1% in adolescents from the Danish general population [22] to 100% in selected patient populations [23]. Some studies observed an association between VESC and back pain [24] [25] [26] [27], whereas other studies did not observe any association [28] [29] [30] [31]. Studies correlating VESC on consecutive MRIs in patients with sciatica are limited, especially studies comparing surgery with conservative treatment for the development of VESC. "
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    ABSTRACT: BACKGROUND CONTEXT: Patients with sciatica frequently experience disabling back pain. One of the proposed causes for back pain is vertebral end-plate signal changes (VESC) as visualized by magnetic resonance imaging (MRI). PURPOSE: To report on VESC findings, changes of VESC findings over time, and the correlation between VESC and disabling back pain in patients with sciatica. STUDY DESIGN/SETTING: A randomized clinical trial with 1 year of follow-up. PATIENTS SAMPLE: Patients with 6 to 12 weeks of sciatica who participated in a multicenter, randomized clinical trial comparing an early surgery strategy with prolonged conservative care with surgery if needed. OUTCOME MEASURES: Patients were assessed by means of the 100-mm visual analog scale (VAS) for back pain (with 0 representing no pain and 100 the worst pain ever experienced) at baseline and 1 year. Disabling back pain was defined as a VAS score of at least 40 mm. METHODS: Patients underwent MRI both at baseline and after 1 year follow-up. Presence and change of VESC was correlated with disabling back pain using chi-square tests and logistic regression analysis. RESULTS: At baseline, 39% of patients had disabling back pain. Of the patients with VESC at baseline, 40% had disabling back pain compared with 38% of the patients with no VESC (p=.67). The prevalence of type 1 VESC increased from 1% at baseline to 35% 1 year later in the surgical group compared with an increase from 3% to 11% in the conservative group. The prevalence of type 2 VESC decreased from 40% to 29% in the surgical group while remaining almost stable in the conservative group at 41%. The prevalence of disabling back pain at 1 year was 12% in patients with no VESC at 1 year, 16% in patients with type 1 VESC, 11% in patients with type 2 VESC, and 3% in patients with both types 1 and 2 VESC (p=.36). Undergoing surgery was associated with increase in the extent of VESC (odds ratio [ OR], 8.6; 95% confidence interval [CI], 4.7-15.7; p <.001). Patients who showed an increase in the extent of VESC after 1 year did not significantly report more disabling back pain compared with patients who did not show any increase (OR, 1.2; 95% CI, 0.6-2.6; p=.61). CONCLUSION: In this study, undergoing surgery for sciatica was highly associated with the development of VESC after 1 year. However, in contrast with the intuitive feeling of spine specialists, those with and those without VESC reported disabling back pain in nearly the same proportion. Therefore, VESC does not seem to be responsible for disabling back pain in patients with sciatica.
    The spine journal: official journal of the North American Spine Society 11/2013; 14(2). DOI:10.1016/j.spinee.2013.08.058 · 2.43 Impact Factor
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    • "Two recent publications suggest a possible relationship between bone marrow abnormalities revealed by MRI and discogenic pain [4] [28]. In these studies, moderate and severe types 1 and 2 endplate abnormalities were considered abnormal, and all the tested discs caused concordant pain on provocation [6]. Ohtori et al. reported that endplate abnormalities in patients with discogenic pain are related to inflammation and axonal growth into the abnormal bone marrow induced by cytokines, such as tumor necrosis factor-í µí»¼ [29]. "
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    05/2013; 2013(3):806267. DOI:10.1155/2013/806267
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