The lumbar spinal endplate lesions grades and association with lumbar disc disorders, and lumbar bone mineral density in a healthy Chinese cohort

Background Lumbar vertebral endplates lesions (LEPLs), as one of the etiology of low back pain (LBP) which is one of the most common causes of health care cost, have an unclear pathogenesis. Although it gradually regarded as the focus in recent years, almost all studies have focused on symptomatic people, not healthy people. Therefore, our study was designed to determine the prevalence and distribution patterns of LEPLs and their associations with lumbar disc herniation (LDH), lumbar disc degeneration (LDD), and lumbar vertebral volumetric bone mineral density (vBMD) in a health cohort. Methods Seven hundred and fifty healthy participants aged 20–60 years were enrolled in the study from a study on the degeneration of the spine and knee. In this observational study, a lumbar quantitative computed tomography (QCT) and MRI scan were performed among participants within 48 hours. T2-weighted sagittal lumbar MRI images for all included subjects were identified for LEPLs by two independent observers based on morphological and local characteristics. Lumbar vertebral vBMD was measured with QCT. The age, BMI, waistline, hipline, lumbar vBMD, LDD, and LDH were measured to investigate their associations with LEPLs.Results The prevalence was higher among the male subjects. 80% of endplates were recognition as no lesions with a significant difference between female (75.6%) and male subjects (83.4%) (p < 0.001). The most common lesions were “wavy/irregular” and “notched”, and “fracture” is most involved in L3-4 inferior endplate both in two genders. Lesions were found to be associated with LDH (≥2 levels： OR=6.859, P＜0.001； 1 level： OR=2.328， P=0.002 in men. OR=5.004, P＜0.001； OR=1.805， P= 0.014 in women) reference for non-LDH, and hipline in men(OR=1.123, P＜0.001). Weighted kappas of 0.66 and 0.87 were, respectively, assessed for the inter-and intra-observer reliabilities of the classification system. Conclusions Endplate lesions are also the common findings on lumbar MRIs in general people, particularly in men, and the presence, and advance from slightly to severely could be mainly attributed to LDH and men’s higher hipline.