Endplate degeneration observed on magnetic resonance imaging of the lumbar spine: correlation with pain provocation and disc changes observed on computed tomography diskography.

STUDY DESIGN One hundred and three lumbar intervertebral discs (L3/4-L5/S1) of 36 patients with low back pain were examined with computed tomography (CT) diskography and magnetic resonance imaging (MRI). OBJECTIVES To determine whether lumbar endplate degeneration correlates with the degree of disc degeneration or disc rupture and to determine if there is an association between pain provocation during diskography and lumbar endplate degeneration. SUMMARY OF BACKGROUND DATA There have been numerous attempts to explain the pathogenesis of pain provocation during diskography, but the possibility of endplate degeneration as a source of pain has not been widely assessed. METHODS One hundred and three lumbar intervertebral discs (36 L3/4, 36 L4/5, and 31 L5/S1 intervertebral discs) of 36 patients were examined. On the basis of MRI, the intervertebral discs were divided into four categories based on the degree of endplate degeneration. Based on pain provocation on diskography, the intervertebral discs were divided into three categories: no pain, indifferent/untypical pain, and familiar/typical pain. Based on disc degeneration and disc rupture, the intervertebral discs were divided into four categories in accordance with the Dallas Discogram Description: Grades 0-3 of both degeneration and rupture. RESULTS There was a positive correlation between endplate degeneration and disc degeneration and a positive correlation between disc rupture and pain provocation, but there was no association between endplate degeneration and disc rupture and no correlation between endplate degeneration and pain provocation on diskography. CONCLUSIONS This study showed a stronger association between endplate degeneration and disc degeneration than between endplate degeneration and disc rupture. The results indicate that the contrast injection during diskography reflects mainly pain of discogenic origin, whereas the possible pain associated with endplate damage cannot be depicted by CT diskography.