Endplate defect is heritable, associated with low back pain and triggers intervertebral disc degeneration: A longitudinal study from Twinsuk

Study Design. Longitudinal study of spine magnetic resonance change (MC) were assessed using standard techniques. Mixed-imaging (MRI) in a large-scale population-based study. effects models were used to determine the association between Objective. To determine the order of appearance of degenera-the features of spine pathology, adjusted for covariates. Endplate tive change in vertebral bodies and intervertebral discs. We also defect heritability was estimated using variance component sought to define the influence of endplate defect on low back analysis. pain (LBP) and to determine whether there is a genetic influence Results. Significant association was found between endplate on endplate defect. defect, LDD, MRI features of LDD and MC was observed. Summary of Background Data. Endplate defect is a mag-Endplate defect was associated with severe disabling LBP netic resonance imaging trait, found to be associated with (P 0.013) in multivariate analysis. An association between intervertebral disc degeneration. There is a lack of understanding disc degeneration (DD) at baseline and MC at follow-up was regarding the mechanism underlying lumbar disc degeneration shown at upper lumbar levels. Total endplate score was (LDD). Recent attention has shifted to vertebral endplate defects heritable with estimated additive genetic component A ¼ 55.3% and their role in spine degeneration pathology. (95% CI 43.0–65.4). Methods. Individuals from the TwinsUK spine study having Conclusion. Endplate defect, LDD, and MC are all indepen-longitudinal T2-weighted lumbar MR scans at baseline (n ¼ 996) dent risk factors for episodes of severe and disabling LBP. and a decade later (n ¼ 438) were included. LDD, vertebral Longitudinal analysis showed DD is followed by MC. Endplate endplate defect by calculating a total endplate score, and Modic defect has significant heritability of 55%. However, whether endplate defect triggers DD or these pathological changes occur concurrently could not be conclusively determined.