Relationship Between The Endplate Degeneration And The Lumbar Intervertebral Disc Degeneration

Objective:In combination with multiple imaging data,we analyzed the correlation between the different types of endplate degeneration and the lumbar intervertebral disc degeneration.Bcakground:Intervertebral disc is an important component of the spine and plays an critical role in maintaining spinal stability and normal physiological function.The endplate is an vital structure which is closely connected with the intervertebral disc and supplies nutrients to the intervertebral disc.Endplate degeneration may be the precursor of intervertebral disc degeneration,suggesting the occurrence of intervertebral disc degeneration.We believe that different types of endplate changes in imaging may have different effects on lumbar disc degeneration.Methods:From March 2017 to December 2017,we retrospectively analyzed the clinical data of 349 patients with low back pain admitted to the Department of Spinal surgery,Zhongda hospital affiliated to Southeast university.We assessed the endplate degeneration,the degree of disc degeneration,the level of facet joint osteoarthritis and the paraspinal fat content at L4-L5 level,and collected personal information(gender,age,smoking history,height,weight and BMI).Univariate analysis was performed by chi-square test on age,BMI,smoking history,sex,Modic change,endplate defect,facet joint osteoarthritis,paraspinal fat content and lumbar disc degeneration.Then the significant factors(P<0.1)were included in the multivariate analysis.The grade of lumbar intervertebral disc degeneration was divided into two categories.The independent risk factors were further selected by binary Logistic regression analysis,P < 0.05 was considered to be statistically significant..Results A total of 349 patients were enrolled,including 197 males and 152 females,aged from 18 to 82 years old(48.7 ±15.0 years old,24.3 ±3.14Kg/ m ^ 2)and the incidence of endplate defect was about 49.0%,of which Erosive endplate defect was the most common,about 56%.Focal endplate defect was the second,about 26%,Corner type endplate defect was the least common,about 18%.Univariate analysis showed that age,gender,BMI,endplate defect,Modic changes and facet joint osteoarthritis were associated with lumbar disc degeneration,but no correlation was found between the paravertebral fat content and smoking and lumbar intervertebral disc degeneration.We further incorporate the statistically significant factors intothe binary logistics regression model.Finally,we found that gender(OR=1.144,P=0.629)was not an independent influencing factor of lumbar disc degeneration,but age(OR=1.619,P=0.008),BMI(OR=1.482,P=0.046),Modic change(OR=2.139,P=0.042),facet joint osteoarthritis(OR=3.006,P= < 0.001)and endplate defect(P < 0.001)were independent risk factors for lumbar disc degeneration.There was no significant difference between the degree of lumbar intervertebral disc degeneration with focal endplate defect and that of normal endplate.The intervertebral disc with Erosive or Corner endplate defect was more likely to develop intervertebral disc degeneration than that of normal type endplate.Conclusions Among the different types of end plate defects,Erosive endplate defect is the most common,followed by focal endplate defect,Corner endplate defect is the least.With the increase of age or BMI,it is easier to induce severe intervertebral disc degeneration.The endplate with Modic changes or severe facet joint osteoarthritis can induce severe intervertebral disc degeneration.Compared with the normal type of endplate,Erosive or Corner endplate defect more prone to induce intervertebral disc degeneration,but the degree of intervertebral disc degeneration of focus endplate defect was not significantly different from that of normal endplate.