Keywords : cartilaginous endplates herniation

MRI Finding of Cartilaginous Endplates Herniation of Lumbar Spine in Patient with Low Back Pain

Iraqi Postgraduate Medical Journal, 2018, Volume 17, Issue 4, Pages 328-334

Magnetic resonance imaging (MRI) provides a noninvasive assessment of the lumbar spine. Little is
thought about the MRI characteristics of cartilaginous endplate (CEP) and CEP herniation on the
ground that their normal thickness is only 0.6mm, making it hard to perceive at routine MRI
To study the reliable magnetic resonance imaging findings suggested cartilage endplate herniation in
lumbar spine.
This prospective study was conducted on 46 patients with low back pain in the MRI unit of Al-
Imamein Alkadhmein Medical City, Baghdad, Iraq between September, 2016 and August 2017.
Inclusion criteria: adult patients with lumbar disc herniation proved by MRI with surgical prove of
cartilage end plates herniation. Exclusion criteria include: patients with previous back surgery,
history of spinal tumor and the general contraindications to MRI. Sagittal and axial T1-weighted
spino-echo image and sagittal and axial T2 weighted spine echo images were obtained. Statistical
analysis using SPSS version 23, the level of significance (p value) was set as ≤ 0.05.
Forty six patients with low back pain were included in this study, the mean age of 44±9 years, 26
patients were females and 20 patients were males.The CEP herniation was detected by MRI among
52.2% of patients with back pain. There was a highly significant association between CEP and
increased age of the patients, back pain radiated to both limbs, L4-5 defect site, modic changes and
lumbar posterior marginal nodes (p value 0.01, 0.004, 0.02, 0.03 and <0.001 respectively). No
significant differences between patients with CEP herniation and those without CEP herniation
regarding posterior osteophytes, dorsal vertebral cornal defect, heterogeneous signal intensity and
posterior corner and mid endplate irregularities. There was a highly significant association between
lumbar posterior marginal nodes and CEP herniation (p<0.001).
CEP herniation is more prevalent among advanced age and at lower lumbar level. The most common
MRI signs related to CEP herniation were modic changes in mid endplate and lumbar posterior
marginal nodes.