Goal of the Study?
In this systematic review and meta-analysis article from the Springer Nature 2021 Journal1 the authors’ goal was to summarize the current state of knowledge on the association between vertebral endplate structural defects and back pain. Wherever possible they were also interested in whether reported differences in associations were due to variations in vertebral endplate structural phenotype or the back pain definition used or the population studied.
Why are they doing this study?
Pain generation and pain transmission require innervated tissues. The vertebral endplate, with its rich blood supply, may be chemically or mechanically sensitized to serve as a source of pain. But there are many inconsistencies in the degree of the association of back pain and vertebral endplate structural defects. This survey and meta-analysis of existing literature is an attempt to better understand these inconsistencies and determine if there is any commonality in these articles and also identify potential future research avenues.
What was done?
Five medical research databases were extensively searched for an association between endplate structural defects and back pain. After removing duplicates this yielded 2,767 article abstracts of which yielded 192 full-text articles and 26 case studies that included a total of 11,027 subjects from 11 countries and three continents. Asia (10), Europe (8) and North America (8). These publications spanned the last 30 years, with half of them in the last decade. Cross-sectional studies were the most common (15), followed by cohort studies (7) and case-controlled studies (4). The strength of association between back pain and endplate structural defects from the 26 studies were very inconsistent. The authors attributed this to inconsistencies in measurement and aggregation techniques, terminology and population studied.
What did they find?
From the articles examined there appears to be moderate-quality evidence supporting an association between back pain and vertebral endplate structural defects. This was most evident for erosion, sclerosis and Schomorl’s nodes.
Why do these findings matter?
The results of this systematic review lead to recommendations for future research. Firstly there is a need for the standardization of nomenclature and measurement methods of endplate structural defect phenotypes and back pain cause definitions. Secondly, more attention must be given to potentially confounding factors, such as differences in various imaging results and their association with back pain. There is also a need for robust longitudinal studies into the role of endplate defects in the causation of specific back pain phenotypes.
At Dynamic Disc Designs we have worked to model the dynamics of the disc to garner more attention to the education of the all aspects of the disc, including the endplates.