Abstract
It has been reported that sensory nerves exist in the intervertebral disc and endplate and that these transmit pain sensation. In the present study we aimed to investigate the association with discogenic pain of abnormalities of the lumbar intervertebral discs and, in particular, the adjacent lumbar endplate, on magnetic resonance imaging (MRI). Using MRI we evaluated 47 patients with low back pain who had undergone anterior discectomy with successful mitigation of pain. Discography reproduced low back pain in all patients. 1) A normal endplate was recognized in 30% of the patients (normal group); endplate abnormality was recognized in 70% of patients (Type A: 14 cases; low signal intensity) and Type B (19 cases) for high signal intensity of a T1-weighted image. 2) The extent of disc degeneration in the Type A and B groups was more severe than in the normal group. 3) Significant intervertebral instability in the normal group was seen compared with the Type A and B groups. Some patients show normal endplate and moderate disc degeneration but severe intervertebral instability with symptomatic discogenic pain. In those showing intervertebral stability, however, abnormal endplate caused discogenic low back pain.
