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Observational Study
. 2022 Jul;31(7):1866-1872.
doi: 10.1007/s00586-022-07206-x. Epub 2022 Apr 20.

The contributions of cartilage endplate composition and vertebral bone marrow fat to intervertebral disc degeneration in patients with chronic low back pain

Noah B Bonnheim  1 , Linshanshan Wang  1 , Ann A Lazar  2 , Jiamin Zhou  3 , Ravi Chachad  3 , Nico Sollmann  3   4   5   6 , Xiaojie Guo  1 , Claudia Iriondo  3 , Conor O'Neill  1 , Jeffrey C Lotz  1 , Thomas M Link  3 , Roland Krug  3 , Aaron J Fields  7
Affiliations
Observational Study

The contributions of cartilage endplate composition and vertebral bone marrow fat to intervertebral disc degeneration in patients with chronic low back pain

Noah B Bonnheim et al. Eur Spine J. 2022 Jul.

Abstract

Purpose: The composition of the subchondral bone marrow and cartilage endplate (CEP) could affect intervertebral disc health by influencing vertebral perfusion and nutrient diffusion. However, the relative contributions of these factors to disc degeneration in patients with chronic low back pain (cLBP) have not been quantified. The goal of this study was to use compositional biomarkers derived from quantitative MRI to establish how CEP composition (surrogate for permeability) and vertebral bone marrow fat fraction (BMFF, surrogate for perfusion) relate to disc degeneration.

Methods: MRI data from 60 patients with cLBP were included in this prospective observational study (28 female, 32 male; age = 40.0 ± 11.9 years, 19-65 [mean ± SD, min-max]). Ultra-short echo-time MRI was used to calculate CEP T2* relaxation times (reflecting biochemical composition), water-fat MRI was used to calculate vertebral BMFF, and T1ρ MRI was used to calculate T1ρ relaxation times in the nucleus pulposus (NP T1ρ, reflecting proteoglycan content and degenerative grade). Univariate linear regression was used to assess the independent effects of CEP T2* and vertebral BMFF on NP T1ρ. Mixed effects multivariable linear regression accounting for age, sex, and BMI was used to assess the combined relationship between variables.

Results: CEP T2* and vertebral BMFF were independently associated with NP T1ρ (p = 0.003 and 0.0001, respectively). After adjusting for age, sex, and BMI, NP T1ρ remained significantly associated with CEP T2* (p = 0.0001) but not vertebral BMFF (p = 0.43).

Conclusion: Poor CEP composition plays a significant role in disc degeneration severity and can affect disc health both with and without deficits in vertebral perfusion.

Keywords: Cartilage endplate; Chronic low back pain; Intervertebral disc degeneration; Quantitative magnetic resonance imaging (MRI); Vertebral bone marrow.

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Conflict of interest statement

The authors have no relevant disclosures.

Figures

Fig. 1
Fig. 1
Representative MRI image, tissue segmentations, and biomarker visualization for the cartilage endplate (top row), vertebral bone marrow (middle row), and intervertebral disc (bottom row). CEP = cartilage endplate, BMFF = bone marrow fat fraction, NP = nucleus pulposus
Fig. 2
Fig. 2
Scatter plots showing the independent relationships between NP T1ρ and a vertebral BMFF and b CEP T2*
See this image and copyright information in PMC

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