RRS Education Chiropractic BLOG - Musculoskeletal Research Reviews

For years, we have been discussing and emphasizing the poor association between most imaging findings (primarily via X-ray) and low back pain symptomatology and severity…this week’s Review explores a specific type of finding (endplate structural defects) and updates our understanding of the moderate quality evidence that they are related to back pain. There is nuance in everything we do clinically, and interpretation of imaging is certainly one of those areas!

Vertebral Endplate Defects:
Vertebral endplate defects have been suggested to be a potential source of back pain. They are certainly a possible pain generator due to their blood and nerve supply, which renders them vulnerable to mechanical or neural sensitization. However, existing evidence has produced inconsistent findings, with some studies showing an association of endplate defects and back pain, while others did not, which can be a result of a variety of factors. Some of these factors include: 1) the multifactorial nature of back pain (with different etiologies potentially being present in different study populations); 2) studies not consistently controlling for potential confounding factors; and 3) lack of formal standardization for the classification and measurement of endplate defects (some studies examine specific types of defects and others aggregate them together).
As a result of the conflicting evidence, and the potential clinical significance of endplate structural defects, the objective of this systematic review was to determine if an association between vertebral endplate structural defects and back pain exists.
THIS WEEK'S RESEARCH REVIEW: “Association Between Vertebral Endplate Structural Defects and Back Pain”
This paper was published in the European Spine Journal (2021) and this Review is posted in Recent Reviews, Low Back Pain, Diagnostic Imaging and the 2021 Archive.
Schmorls node

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