Evaluation of asymptomatic lumbar disc herniation and endplate failure in general population and their significance in development of low backache

Sudhir Kumar Mahapatra, Madan Mohan Sahoo, Udit Sourav Sahoo, Sheetal Kaur, Manoranjan Mohapatra
2021 International Journal of Orthopaedics Sciences  
Despite being the most common cause of low back pain, there are wide variations in the pathogenesis and management of lumbar disc herniation (LDH). Previously the nucleus pulposus was being implicated for most of the symptoms, but recent papers propose the endplate failure (EPF) as the most important component of symptomatic LDH. However considering the abundance of the asymptomatic LDH in normal population, it is important to study the association of endplate failure in general population to
more » ... derstand it's contribution in symptomatic LDH. Aim: To evaluate the incidence of asymptomatic LDH and EPF in normal population and note development of any low back pain in them. Material and Methods: Adult patients presenting outdoor with complains other than present or past history of low backache were evaluated clinically and radiologically [x-ray, CT scan, MRI scan including the fat suppressed 3D fast spoiled gradient sequences (3DFSPGR)] to note status of lumbar disc and endplate. They were then, prospectively followed up for 3 years for any occurrence of backache. Results: Twenty volunteers (13 males, 7 females) were studies from age 19-50 years (mean 33.6±10.3). Six volunteers (30%) had desiccation of one or more lumbar disc and 8 volunteers (40%) had LDH at one or more levels. However all of the LDH were broad based disc bulge. Three volunteers had cartilaginous EPF and 1 had bony EPF. None of the EPFs were associated with disc desiccation, but 2 were associated with LDH. The presence of disc desiccations and LDH were significantly correlated to the increasing age but the EPF had no such age correlation. Subsequently 2 volunteers developed low backache. Conclusion: Asymptomatic disc desiccation and lumbar disc bulge is fairly common. Their mere presence may not be the cause of the low backache and should be carefully considered for any surgical planning. However presence bony EPF is rare and may have some significance in development of symptomatic LDH.
doi:10.22271/ortho.2021.v7.i4h.2937 fatcat:4hejlfa2jnfwbempbg4oxx35bi