From the Guidelines
Endplate degenerative changes of the lumbar spine are a common finding in asymptomatic individuals and do not necessarily correlate with symptoms, as evidenced by a prospective study by Carragee et al 1 that found 84% of patients with lumbar imaging abnormalities before the onset of low back pain had unchanged or improved findings after symptoms developed.
Definition and Causes
Endplate degenerative changes refer to the deterioration of the bony surfaces (endplates) that connect vertebrae to intervertebral discs in the lower back. These changes can develop as part of the normal aging process and can be accelerated by factors such as repetitive stress, trauma, or genetic predisposition.
Symptoms and Diagnosis
Common symptoms of endplate degenerative changes include lower back pain that may worsen with activity, stiffness, and reduced flexibility. However, some people may experience no symptoms at all. These changes are typically identified through imaging studies like MRI or CT scans.
Treatment and Management
Treatment usually focuses on managing symptoms through:
- Physical therapy
- Anti-inflammatory medications like ibuprofen or naproxen
- Lifestyle modifications such as maintaining proper posture and weight management In severe cases where pain significantly impacts daily activities, more advanced interventions like steroid injections or, rarely, surgery might be considered. As noted in the study by Manchikanti et al 1, lumbar discography may be useful in patients with chronic discogenic low back pain, and MRI of the lumbar spine is the initial imaging modality of choice for identifying potential actionable pain generators.
Key Points to Consider
- Endplate degenerative changes are common in asymptomatic individuals and do not necessarily correlate with symptoms 1
- Imaging studies like MRI or CT scans are typically used to identify these changes
- Treatment focuses on managing symptoms and preventing further deterioration, rather than reversing the changes themselves
- A systematic review by Manchikanti et al 1 provides level III evidence that lumbar discography may be useful in patients with chronic discogenic low back pain.
From the Research
Definition of Endplate Degenerative Changes
Endplate degenerative changes refer to the deterioration of the endplates, which are the interfaces between the vertebral bodies and the intervertebral discs in the spine. These changes can include defects, damage, or alterations in the morphology and composition of the endplates.
Characteristics of Endplate Degenerative Changes
- Endplate defects can be identified and measured using MRI, with dimensions such as maximum width and depth being significant 2.
- Degenerative endplate changes can be associated with disc degeneration, Modic changes, facet joint abnormalities, and pain 2.
- Perfusion profiles of degenerative endplate marrow changes can differ significantly from normal marrow, regardless of spinal level, age, or sex 3.
Relationship with Other Spinal Conditions
- Endplate degenerative changes can be related to disc degeneration, Modic changes, facet joint degeneration, and spinal stenosis 4.
- The progression of endplate degeneration can be influenced by factors such as scoliotic deformity and lumbar lordosis 5.
- Endplate dysfunction can associate with disc degeneration and axial low back pain, with changes to endplate morphology and composition impairing its permeability 6.
Clinical Significance
- Endplate degenerative changes can be a significant factor in the development of disc degeneration and low back pain 6.
- Assessing endplate findings from a multi-dimensional perspective can have clinical utility 2.
- Dynamic contrast-enhanced MRI can be used to evaluate perfusion profiles of degenerative endplate marrow changes 3.