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Characterizing the Morphology of Vertebral Endplate Defects: A Study of Human Cadaveric Spines Using Micro‐CT
Author(s) -
Faul James,
Battié Michele
Publication year - 2021
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.2021.35.s1.03509
Subject(s) - cadaveric spasm , anatomy , vertebra , medicine , cadaver , calcification , radiology
Back pain has been associated with vertebral endplate defects; however, findings have been inconsistent and there is substantial miscommunication surrounding the classification of different types of endplate defects observed on clinical imaging. A recent scoping review showed that 34 different terms have been used to describe various subtypes of endplate defects, many of which appear to represent the same structural abnormality. A comprehensive study of the different types of endplate structural defects is needed in order to clarify their character and prevalence. Objective This study aims to provide a thorough depiction of vertebral endplate defects classified on the basis of their morphological features and reported with respect to size, location, and prevalence in human cadaveric spines of older adults. Methods Using Micro‐CT scans, three‐dimensional reconstructed images were created of 411 endplates in the thoracolumbar (T6‐S1) spine of 19 ethanol‐phenol embalmed cadaveric specimens (9 men and 10 women, aged 62‐91). Each endplate was evaluated, and defects were identified and categorized based on their morphological characteristics. The size and location of each defect was also recorded in order to evaluate defect severity and distributions patterns. Results Seven types of endplate defects were identified, including Schmorl's Nodes, erosion, calcification, corner fracture or limbus vertebra, other fracture‐like lesions, compression, and jagged appearance. Endplate defects of >2 mm were identified on 63.5% (261) of the 411 endplates. Further, at least 2 defects were identified on 18.9% (78) of the endplates, and 3 defects were identified on 2.9% (12) of endplates. Fractures were the most common type of lesion (30.4%), followed by erosion (20.5%), and jagged surfaces (15.6%). Schmorl's Nodes constituted 8.3% of lesions. Defects were often misclassified if only viewed on sagittal images. Conclusion To the best of our knowledge, this study provides the first thorough investigation of the morphology and distribution of vertebral endplate defects using micro‐CT. The results demonstrate the presence of distinct endplate defect phenotypes with different prevalence rates. Furthermore, both defect type and size may be misrepresented if assessed only from sagittal images, as are typically used in clinical imaging. Research distinguishing endplate defect phenotypes, sizes, and distribution patterns may be critical to elucidating their etiology and role in low back pain.