Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada.
Spine (Phila Pa 1976). 2012 Aug 1;37(17):1490-6. doi: 10.1097/BRS.0b013e3182608ac4.
An autopsy study.
To investigate associations between various types of lumbar endplate lesions, disc degeneration (DD), and back pain history.
The well-innervated vertebral endplate has been suspected as a source of back pain. Previously, we observed 4 types of lumbar endplate lesions with distinct morphological characteristics. Their roles in DD and back pain remain unclear.
From a lumbar spine archive of 136 men (mean age, 52 yr), back pain, back injury, and occupation history data for 69 subjects and discography data for 443 discs from 109 subjects were available for study. Back pain history was categorized as none, occasional, or frequent. DD was judged from discography. Endplate lesions were classified as Schmorl's nodes, fracture, erosion, or calcification, and lesion size was rated as none, small, moderate, or large. Associations between endplate lesions and DD, back pain history, back injury, and occupation history were examined.
Presence of endplate lesions was associated with frequent (odds ratio [OR] = 2.57) but not occasional back pain. However, large endplate lesions were associated with both occasional (OR = 8.68) and frequent (OR = 17.88) back pain. This association remained after further controlling for DD. Also, the presence of each type of endplate lesion was associated with adjacent DD (OR = 2.40-9.71), with larger lesions associated with more severe DD. Endplate erosion lesions were more strongly associated with adjacent DD than Schmorl's nodes. Although back injury history was associated with the presence of fracture and erosion lesions, heavy occupation was associated with the presence of Schmorl's nodes.
Endplate lesions are associated with back pain as well as being closely associated with adjacent DD, with a clear dosage effect. Different types of endplate lesions seem to have different magnitudes of associations with DD. Lumbar endplate lesions may be an important key to better understand both DD and back pain.
尸体研究。
研究各种类型的腰椎终板病变、椎间盘退变（DD）与背痛史之间的关系。
富含神经的椎体终板被怀疑是背痛的来源。之前，我们观察到 4 种具有不同形态特征的腰椎终板病变。它们在 DD 和背痛中的作用尚不清楚。
从 136 名男性（平均年龄 52 岁）的腰椎存档中，对 69 名受试者的背痛、背部损伤和职业史数据以及 109 名受试者的 443 个椎间盘的椎间盘造影数据进行了研究。背痛史分为无、偶发或频发。DD 通过椎间盘造影判断。终板病变分为 Schmorl 结节、骨折、侵蚀或钙化，并对病变大小进行分级，分为无、小、中、大。研究了终板病变与 DD、背痛史、背部损伤和职业史之间的关系。
终板病变的存在与频发（比值比[OR] = 2.57）而非偶发性背痛有关。然而，大的终板病变与偶发（OR = 8.68）和频发（OR = 17.88）背痛均有关。在进一步控制 DD 后，这种相关性仍然存在。此外，每种终板病变的存在均与相邻 DD 相关（OR = 2.40-9.71），病变越大，DD 越严重。终板侵蚀性病变与相邻 DD 的相关性强于 Schmorl 结节。虽然背部损伤史与骨折和侵蚀性病变的存在有关，但重体力劳动与 Schmorl 结节的存在有关。
终板病变与背痛有关，与相邻 DD 密切相关，具有明显的剂量效应。不同类型的终板病变与 DD 的关联程度似乎不同。腰椎终板病变可能是更好地理解 DD 和背痛的一个重要关键。
