Lumbar Vertebral Endplate Defects On MRI In Degenerative Spondylolisthesis And Risk Factor Analysis

Objective: Endplate defects are commonly seen in lumbar degenerative diseases and are associated with intervertebral disc degeneration(IDD)and chronic back pain.The present study observed characteristics of endplate defects in patients with degenerative spondylolisthesis(DS)based on MRIs,and found the incidence rates and distribution patterns of endplate defects.The study also explored risk factors associated with endplate defects in DS.Methods: The study collected 204 monosegment DS patients.A total of 159 patients were finally included(35 men and 124 women,and the age was 60.6 ±8.7 years).Medical records,MR images and X ray images were retrospectively collected.According to our observation on MRIs and previous studies,endplate defects were classified into 3 major categories(rim defects,focal defects and erosive defects)and 5 subtypes(anterior type,posterior type,arc type at the anterior rim,notch type and Schmorl's nodes).The study explored incidence rates and distribution characters of endplate defects in different lumbar levels.Incidence rates of endplate defects were compared between slippage levels and non-slippage levels.The correlations between the endplate defects and slip segment,slip degree,age,sex,body mass index(BMI),disc degeneration and Modic changes(MCs)were analyzed.Results: Endplate defects occurred in 47.43% of endplates in the concluded patients.The most common endplate defects were rim defects(65.08%).In general,the incidence rates were higher in superior endplate(SEP)than in inferior endplate(IEP).The occurrence of endplate defects was more common at slippage levels than that at non-slippage levels.As for subtypes,the incidence rate of anterior defect at slippage levels was significantly higher than that at other levels.Endplate defects were associated with age and closely related to MCs and the severity of disc degeneration.Slip degree,segment difference,BMI and sex difference were not associated with endplate defects in our study.Conclusions: Endplate defects had various morphology and distribution characters.Slippage promoted the occurrence of endplate defects at slippage segments,but endplate defects were not associated with slippage degree or slippage segment difference in DS.In addition,age,disc degeneration and MCs were risk factors for endplate defects.Endplate defects,disc degeneration and MCs could interact,which provided new ideas for studying the mechanism of DS and the degenerative changes in DS.