Vertebral end-plate changes: Are they clinically significant for postoperative low back pain?

Background: Our aim was to assess the relationship between postoperative recurrent low back pain and vertebral body end-plate signal intensity changes on magnetic resonance imaging in disc herniation patients. Materials and Methods: The preoperative magnetic resonance images of 748 patients were retrospectively reviewed. End-plate changes were separated into three groups according to the Modic classification. The postoperative clinical improvement was defined according to the Kawabata criteria. The localization and type of end-plate degeneration and improvement after the operation were analyzed with Pearson's Chi-square test. Results: End-plate degeneration was found in 394 of 748 patients. Single-level and multiple-level end-plate changes were present in 70.4% and 29.6% of the patients, respectively. Type 2 (85.5%), type 1 (10.7%), and type 3 (3.8%) degenerations were encountered in order of frequency. The severities of the end-plate changes were mild, moderate, and severe in 63.2%, 32.7%, and 4.1% of the patients. Type 1 and type 2 degenerations correlated with clinical course in the postoperative period (P < 0.05). Conclusions: Type 1 and type 2 degenerative end-plate changes seen on preoperative magnetic resonance scans can influence the clinical course and be an indicator of postoperative back pain.