• Eur Spine J · Feb 2025

    ISSLS Prize in Clinical Science 2025: Cartilage End Plate Defects Precede and Initiate Bony End Plate Defects and Disc Degeneration- An 'Integrated Total End Plate Score' Identify Preclinical Discs at Risk for Degeneration.

    • Shanmuganathan Rajasekaran, Pushpa Bhari Thippeswamy, Gnanaprakash Gurusamy, Karthik Ramachandran, Tewodros Asegie Yirdaw, Suprotik Basu, Jinal Sanjiv Kamodia, Ayman Mohamed Abdelwahed, K SSri Vijay AnandSVAGanga Hospital, Coimbatore, Tamil Nadu, India.Ganga Research Centre, Coimbatore, Tamil Nadu, India., Ajoy Prasad Shetty, and Rishi Mugesh Kanna.
    • Ganga Hospital, Coimbatore, Tamil Nadu, India. rajasekaran.orth@gmail.com.
    • Eur Spine J. 2025 Feb 6.

    PurposeWe utilized the Fast Low Angle Shot (FLASH) sequence to document the sequential changes in cartilaginous (CEP) and bony end plate (BEP) to study the influence on disc degeneration (DD).MethodsRoutine MRI and FLASH sequences were used in 500 lumbar discs in 100 each of healthy volunteers (HV), low back pain patients treated conservatively (CG) and surgically (SG) to document CEP and BEP status, Pfirrmann Grade (PG) and various MRI parameters.ResultsThe three groups were identical demographically but had a significantly different number of healthy discs (p < 0.01) and changes in CEP and BEP (p < 0.01), with patients having a higher severity of end plate changes and DD, even in asymptomatic discs. CEP abnormalities always appeared first, followed by a sequence of BEP defects of different severity, allowing the development of an 'Integrated Total End Plate Score' (I-TEPS). There was a good correlation between I-TEPS and PG, with a steep escalation of DD after a score of 7. A score of ≥ 7 was also associated with higher surgical incidence in patients with both degenerated and herniated discs. The most significant influencing factors for surgery was a combination of I-TEPS ≥ 7 with herniation (OR7.7;p-0.00), smoking (OR4.63;p-0.02), and an I-TEPS ≥ 7 (OR3.37;p-0.04).ConclusionCEP changes identified by FLASH preceded BEP defects and DD. I-TEPS was superior to TEPS in identifying a subgroup of discs that had CEP abnormalities without BEP. An I-TEPS ≥ 7 had a significant correlation to the severity of DD, influenced variations in herniation and also surgical incidence.© 2025. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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