The Degree of Cervical Intervertebral Disc Degeneration Is Associated With Denser Bone Quality of the Cervical Sub-endplate and Vertebral Body

Abstract

Objective: The relationship between cervical disc degeneration and bone quality of adjacent vertebral body remains controversial. This study aims to investigate the relationship between cervical disc degeneration and bone quality of the adjacent vertebral body and sub-endplate bone with a new MRI-based bone quality score in patients over 50 years with cervical spondylosis.

Methods: We retrospectively reviewed 479 cervical disc segments from 131 patients. Disc degeneration at levels C3/C4–C6/C7 was graded using T2-weighted MRI. Vertebral body quality (VBQ) score and sub-endplate bone quality (EBQ) score from C3 to C7 were computed from T1-weighted MRI images. Additionally, bone mineral density (BMD) of the cervical vertebrae was measured in 52 patients using a novel phantom-less quantitative computed tomography (PL-QCT) system. The correlation between bone quality score and Pfirrmann grade was analyzed and risk factors for VBQ and EBQ were further evaluated.

Results: Significant differences were found in cranial VBQ among different Pfirrmann grades, with a score of 2.55 ± 0.54 for Grade 5 discs, which was lower compared to Grades 4 (2.70 ± 0.56) (p < 0.05) and 3 (2.81 ± 0.58) (p < 0.01). Caudal VBQ for Grade 5 discs (2.43 ± 0.52) was also significantly lower than for Grade 3 discs (2.66 ± 0.54) (p < 0.01). EBQ scores decreased with increasing Pfirrmann grades. Negative correlations were observed between both cranial and caudal VBQ and EBQ scores and Pfirrmann grades. Grades 4 and 5 discs were identified as independent risk factors for decreased caudal VBQ and EBQ, whereas only Grade 5 was a significant risk factor for decreased cranial EBQ. Additionally, a moderate correlation (0.4 < R < 0.6, p < 0.05) was noted between vertebral body BMD and VBQ at each cervical level.

Conclusion: In individuals over 50 years with cervical spondylosis, the severity of disc degeneration was closely correlated with denser bone quality in both the caudal vertebral body and sub-endplate, as measured by VBQ and EBQ scores. These findings suggest that worsening disc degeneration is associated with increased bone density in specific areas of the cervical spine.

References

[1] W. Li, H. Zhao, S. Zhou, et al., “Does Vertebral Osteoporosis Delay or Accelerate Lumbar Disc Degeneration? A Systematic Review,” Osteoporosis International 34 (2023): 1983–2002,

[2] N. V. Vo, R. A. Hartman, P. R. Patil, et al., “Molecular Mechanisms of Biological Aging in Intervertebral Discs,” Journal of Orthopaedic Research 34 (2016): 1289–1306,

[3] C. C. Kuo, M. Soliman, R. A. Baig, et al., “Vertebral Bone Quality Score as a Predictor of Adjacent Segment Disease After Lumbar Interbody Fusion,” Neurosurgery 95 (2024): 284–296,

[4] Y. Ding, J. Y. Chen, J. C. Yang, et al., “Disc Degeneration Contributes to the Denser Bone in the Subendplate but Not in the Vertebral Body in Patients With Lumbar Spinal Stenosis or Disc Herniation,” Spine Journal 23 (2023): 64–71,

[5] R. Li, Y. Yin, W. Ji, et al., “MRI-Based Vertebral Bone Quality Score Effectively Reflects Bone Quality in Patients With Osteoporotic Vertebral Compressive Fractures,” European Spine Journal 31 (2022): 1131–1137,

[6] C. Xue, X. Lu, G. Sun, et al., “Opportunistic Prediction of Osteoporosis in Patients With Degenerative Lumbar Diseases: A Simplified T12 Vertebral Bone Quality Approach,” Journal of Orthopaedic Surgery and Research 19 (2024): 296,

[7] A. Kettler and H. J. Wilke, “Review of Existing Grading Systems for Cervical or Lumbar Disc and Facet Joint Degeneration,” European Spine Journal 15 (2006): 705–718,

[8] M. J. Lee, J. R. Dettori, C. J. Standaert, E. D. Brodt, and J. R. Chapman, “The Natural History of Degeneration of the Lumbar and Cervical Spines: A Systematic Review,” Spine (Phila Pa 1976) 37 (2012): S18–S30,

[9] J. P. Jarman, V. E. Arpinar, D. Baruah, A. P. Klein, D. J. Maiman, and L. T. Muftuler, “Intervertebral Disc Height Loss Demonstrates the Threshold of Major Pathological Changes During Degeneration,” European Spine Journal 24 (2015): 1944–1950,

[10] P. Colombier, J. Clouet, O. Hamel, L. Lescaudron, and J. Guicheux, “The Lumbar Intervertebral Disc: From Embryonic Development to Degeneration,” Joint, Bone, Spine 81 (2014): 125–129,

[11] S. Duran, M. Cavusoglu, H. G. Hatipoglu, C. D. Sozmen, and B. Sakman, “Association Between Measures of Vertebral Endplate Morphology and Lumbar Intervertebral Disc Degeneration,” Canadian Association of Radiologists Journal 68 (2017): 210–216,

[12] B. Ashinsky, H. E. Smith, R. L. Mauck, and S. E. Gullbrand, “Intervertebral Disc Degeneration and Regeneration: A Motion Segment Perspective,” European Cells & Materials 41 (2021): 370–380,

[13] L. A. Setton and J. Chen, “Mechanobiology of the Intervertebral Disc and Relevance to Disc Degeneration,” Journal of Bone and Joint Surgery (American Volume) 88, no. Suppl 2 (2006): 52–57,

[14] P. P. Raj, “Intervertebral Disc: Anatomy-Physiology-Pathophysiology-Treatment,” Pain Practice 8 (2008): 18–44,

[15] A. G. Rodriguez, A. E Rodriguez-Soto, A. J. Burghardt, S. Berven, S. Majumdar, and J. C. Lotz, “Morphology of the Human Vertebral Endplate,” Journal of Orthopaedic Research 30 (2012): 280–287,

[16] Q. Liu, Z. Yang, Y. Liu, et al., “Cervical Spinal Instability Causes Vertebral Microarchitecture Change and Vertebral Endplate Lesion in Rats,” Journal of Orthopaedic Translation 24 (2020): 209–217,

[17] Y. Ding, J. Jiang, J. Zhou, et al., “The Effects of Osteoporosis and Disc Degeneration on Vertebral Cartilage Endplate Lesions in Rats,” European Spine Journal 23 (2014): 1848–1855,

[18] L. Chen, X. Y. Wu, Q. Jin, G. Y. Chen, and X. Ma, “The Correlation Between Osteoporotic Vertebrae Fracture Risk and Bone Mineral Density Measured by Quantitative Computed Tomography and Dual Energy X-Ray Absorptiometry: A Systematic Review and Meta-Analysis,” European Spine Journal 32 (2023): 3875–3884,

[19] S. N. Salzmann, I. Okano, C. Jones, et al., “Thoracic Bone Mineral Density Measured by Quantitative Computed Tomography in Patients Undergoing Spine Surgery,” Spine Journal 21 (2021): 1866–1872,

[20] J. Ehresman, Z. Pennington, A. Schilling, et al., “Novel MRI-Based Score for Assessment of Bone Density in Operative Spine Patients,” Spine Journal 20 (2020): 556–562,

[21] Z. J. Liu, C. Zhang, C. Ma, et al., “Automatic Phantom-Less QCT System With High Precision of BMD Measurement for Osteoporosis Screening: Technique Optimisation and Clinical Validation,” Journal of Orthopaedic Translation 33 (2022): 24–30,

[22] Y. Wang, S. K. Boyd, M. C. Battié, Y. Yasui, and T. Videman, “Is Greater Lumbar Vertebral BMD Associated With More Disk Degeneration? A Study Using µCT and Discography,” Journal of Bone and Mineral Research 26 (2011): 2785–2791,

[23] H. E. Gruber, B. Gordon, C. Williams, H. J. Norton, and E. J. Hanley, “Vertebral Endplate and Disc Changes in the Aging Sand Rat Lumbar Spine: Cross-Sectional Analyses of a Large Male and Female Population,” Spine (Phila Pa 1976) 32 (2007): 2529–2536,

[24] X. Liang, Q. Liu, J. Xu, W. Ding, and H. Wang, “Hounsfield Unit for Assessing Bone Mineral Density Distribution Within Cervical Vertebrae and Its Correlation With the Intervertebral Disc Degeneration,” Frontiers in Endocrinology (Lausanne) 13 (2022): 13,

[25] S. R. Cummings and L. J. Melton, “Epidemiology and Outcomes of Osteoporotic Fractures,” Lancet 359 (2002): 1761–1767,

[26] F. M. Ulivieri, B. C. Silva, F. Sardanelli, D. Hans, J. P. Bilezikian, and R. Caudarella, “Utility of the Trabecular Bone Score (TBS) in Secondary Osteoporosis,” Endocrine 47 (2014): 435–448,

[27] S. W. Hong, K. T. Park, Y. Chung, Y. J. Choi, and J. Kang, “Bone Mineral Density, Cervical Spine Degeneration, Head and Neck Posture, and Neck Pain in the Post-Menopausal Females: A Pilot Study,” PLoS One 16 (2021): e257735,

[28] Q. Sun, F. M. Tian, F. Liu, et al., “Denosumab Alleviates Intervertebral Disc Degeneration Adjacent to Lumbar Fusion by Inhibiting Endplate Osteochondral Remodeling and Vertebral Osteoporosis in Ovariectomized Rats,” Arthritis Research & Therapy 23 (2021): 152,

[29] J. Y. Margulies, A. Payzer, M. Nyska, M. G. Neuwirth, Y. Floman, and G. C. Robin, “The Relationship Between Degenerative Changes and Osteoporosis in the Lumbar Spine,” Clinical Orthopaedics and Related Research 324 (1996): 145–152,

[30] W. Li, H. Zhu, Z. Hua, et al., “Vertebral Bone Quality Score as a Predictor of Pedicle Screw Loosening Following Surgery for Degenerative Lumbar Disease,” Spine (Phila Pa 1976) 48 (2023): 1635–1641,

[31] Y. Huang, Q. Chen, L. Liu, and G. Feng, “Vertebral Bone Quality Score to Predict Cage Subsidence Following Oblique Lumbar Interbody Fusion,” Journal of Orthopaedic Surgery and Research 18 (2023): 258,

[32] D. Sakai and S. Grad, “Advancing the Cellular and Molecular Therapy for Intervertebral Disc Disease,” Advanced Drug Delivery Reviews 84 (2015): 159–171,

[33] M. Turgut, S. Uslu, A. L. Uysal, M. E. Yurtseven, and N. H. St, “Changes in Vascularity of Cartilage Endplate of Degenerated Intervertebral Discs in Response to Melatonin Administration in Rats,” Neurosurgical Review 26 (2003): 133–138,

[34] A. Nachemson, T. Lewin, A. Maroudas, and M. A. Freeman, “In Vitro Diffusion of Dye Through the End-Plates and the Annulus Fibrosus of Human Lumbar Inter-Vertebral Discs,” Acta Orthopaedica Scandinavica 41 (1970): 589–607,

[35] L. Zhou, C. Li, and H. Zhang, “Correlation Between Bone Mineral Density of Different Sites and Lumbar Disc Degeneration in Postmenopausal Women,” Medicine (Baltimore) 101 (2022): e28947,

[36] Y. Zhang, L. B. Patiman, R. Zhang, X. Ma, and H. Guo, “Correlation Between Intervertebral Disc Degeneration and Bone Mineral Density Difference: A Retrospective Study of Postmenopausal Women Using an Eight-Level MRI-Based Disc Degeneration Grading System,” BMC Musculoskeletal Disorders 23 (2022): 833,

[37] A. Harada, H. Okuizumi, N. Miyagi, and E. Genda, “Correlation Between Bone Mineral Density and Intervertebral Disc Degeneration,” Spine (Phila Pa 1976) 23 (1998): 857–861,

[38] D. Zou, W. Li, F. Xu, and G. Du, “Use of Hounsfield Units of S1 Body to Diagnose Osteoporosis in Patients With Lumbar Degenerative Diseases,” Neurosurgical Focus 46 (2019): E6,

[39] P. M. Udby, D. Samartzis, L. Y. Carreon, M. Ø. Andersen, J. Karppinen, and M. Modic, “A Definition and Clinical Grading of Modic Changes,” Journal of Orthopaedic Research 40 (2022): 301–307,

RIGHTS & PERMISSIONS

2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.