Fractures of the lumbar vertebral endplate in the etiology of low back pain: a hypothesis on the causative role of spinal compression in aspecific low back pain.

It is hypothesized that, in a large number of cases of aspecific low back pain, the primary cause of the pain is a fracture of the vertebral endplate caused by compression forces. Clinical studies have shown that, in many low back pain patients, damage of the vertebral bodies and or the intervertebral disc is present. In vitro studies reveal that the most likely type of failure of this anterior part of the spine is a fracture of the endplate as a result of compression. The high incidence of aspecific low back pain concurs with the likeliness of compression fractures of the endplate to occur in everyday life. Furthermore, epidemiological findings and the natural history of low back pain appear to be in line with the proposed hypothesis.

[1]  H Johansson,et al.  Pathophysiological mechanisms involved in genesis and spread of muscular tension in occupational muscle pain and in chronic musculoskeletal pain syndromes: a hypothesis. , 1991, Medical hypotheses.

[2]  D. M. Smith.  Acute back pain associated with a calcified Schmorl's node: a case report. , 1976, Clinical orthopaedics and related research.

[3]  Courtney W. Brown,et al.  Relationship Between Vertebral Intraosseous Pressure, pH, PO2, pCO2, and Magnetic Resonance Imaging Signal Inhomogeneity in Patients with Back Pain: An in Vivo Study , 1991, Spine.

[4]  Gary E. Friedlaender,et al.  Bone formation and repair , 1994 .

[5]  M. Elves,et al.  In vitro inhibition of leucocyte migration in patients with intervertebral disc lesions. , 1975, The Orthopedic clinics of North America.

[6]  J. O'Brien,et al.  Acute Traumatic Intraosseous Disc Herniation , 1985, Spine.

[7]  J. Taylor,et al.  End-Plate Lesions of the Lumbar Spine , 1989, Spine.

[8]  M. Jayson,et al.  The Lumbar Spine and Back Pain , 1993 .

[9]  H. Farfan,et al.  The effects of torsion on the lumbar intervertebral joints: the role of torsion in the production of disc degeneration. , 1970, The Journal of bone and joint surgery. American volume.

[10]  G. Wickström.  Symptoms and signs of degenerative back disease in concrete reinforcement workers. , 1978, Scandinavian journal of work, environment & health.

[11]  G. Andersson,et al.  Discs Degenerate Before Facets , 1990, Spine.

[12]  D G Wilder,et al.  Epidemiologic Studies of Low-Back Pain , 1980, Spine.

[13]  S M McGill,et al.  Studies of spinal shrinkage to evaluate low-back loading in the workplace. , 1996, Ergonomics.

[14]  I. Paul,et al.  Response of joints to impact loading. 3. Relationship between trabecular microfractures and cartilage degeneration. , 1973, Journal of biomechanics.

[15]  G D Herrin,et al.  Prediction of overexertion injuries using biomechanical and psychophysical models. , 1986, American Industrial Hygiene Association journal.

[16]  R. Derby,et al.  Painful Lumbar End-Plate Disruptions: A Significant Discographic Finding , 1988, Spine.

[17]  H. Farfan,et al.  Mechanical disorders of the low back , 1973 .

[18]  Sander Greenland,et al.  Factors associated with self-reported back-pain prevalence: A populationdashbased study , 1985 .

[19]  N. Semmer,et al.  The Diagnostic Accuracy of Magnetic Resonance Imaging, Work Perception, and Psychosocial Factors in Identifying Symptomatic Disc Herniations , 1995, Spine.

[20]  S D Kuslich,et al.  The tissue origin of low back pain and sciatica: a report of pain response to tissue stimulation during operations on the lumbar spine using local anesthesia. , 1991, The Orthopedic clinics of North America.

[21]  Savio Lau-Yuen Woo,et al.  Biomechanics of diarthrodial joints , 1990 .

[22]  Waldemar Karwowski,et al.  Ergonomics in rehabilitation , 1988 .

[23]  A E Goodship,et al.  Can intervertebral disc prolapse be predicted by disc mechanics? , 1993, Spine.

[24]  C. Rubin,et al.  Biologic Modulation of Mechanical Influences in Bone Remodeling , 1990 .

[25]  F. Biering-Sørensen,et al.  A prospective study of low back pain in a general population. I. Occurrence, recurrence and aetiology. , 2020, Scandinavian journal of rehabilitation medicine.

[26]  Adams Ma,et al.  Prolapsed Intervertebral Disc: A Hyperflexion Injury , 1982 .

[27]  M. Adams,et al.  Gradual Disc Prolapse , 1985, Spine.

[28]  N. Bogduk.  The Innervation of the Lumbar Spine , 1983, Spine.

[29]  P. Brinckmann,et al.  Fatigue fracture of human lumbar vertebrae. , 1988, Clinical biomechanics.

[30]  J. Weinstein,et al.  Lumbar discography in normal subjects. A controlled, prospective study. , 1990, The Journal of bone and joint surgery. American volume.

[31]  N. Yoganandan,et al.  Intravertebral pressure changes caused by spinal microtrauma , 1994 .

[32]  J. Seeger,et al.  Traumatic lesions of the discovertebral junction in the lumbar spine. , 1976, AJR. American journal of roentgenology.

[33]  H. Riihimäki,et al.  Back pain and heavy physical work: a comparative study of concrete reinforcement workers and maintenance house painters. , 1985, British journal of industrial medicine.

[34]  P. Brinckmann,et al.  Prediction of the Compressive Strength of Human Lumbar Vertebrae , 1989, Spine.

[35]  T. Yasuma,et al.  SCHMORL'S NODES , 1988 .

[36]  H. Toussaint,et al.  Viscoelasticity of the individual spine. , 1994, Clinical biomechanics.

[37]  N Yoganandan,et al.  Correlation of microtrauma in the lumbar spine with intraosseous pressures. , 1994, Spine.

[38]  N. Bogduk,et al.  The Sacroiliac Joint in Chronic Low Back Pain , 1995, Spine.

[39]  O Lindahl,et al.  Mechanical properties of dried defatted spongy bone. , 1976, Acta orthopaedica Scandinavica.

[40]  A. Naylor.  Intervertebral Disc Prolapse and Degeneration: The Biochemical and Biophysical Approach , 1976 .

[41]  W S Marras,et al.  A literature review of low back disorder surveillance measures and risk factors. , 1997, Clinical biomechanics.

[42]  A E Goodship,et al.  In Vivo Stress Measurement Can Predict Pain on Discography , 1996, Spine.

[43]  L. Bouter,et al.  The Prognosis of Low Back Pain in General Practice , 1997, Spine.

[44]  K. Takahashi,et al.  A large painful Schmorl's node: a case report. , 1994, Journal of spinal disorders.

[45]  Jaap H. van Dieën,et al.  Mechanical behaviour and strength of the motion segment under compression: Implications for the evaluation of physical work load , 1994 .

[46]  T Hansson,et al.  The Relation Between Bone Mineral Content, Experimental Compression Fractures, and Disc Degeneration in Lumbar Vertebrae , 1981, Spine.

[47]  W S Marras,et al.  Biomechanical risk factors for occupationally related low back disorders. , 1995, Ergonomics.

[48]  N. Bogduk,et al.  The Relative Contributions of the Disc and Zygapophyseal Joint in Chronic Low Back Pain , 1994, Spine.

[49]  M. Lockshin,et al.  Auto-immunological basis of disk degeneration. , 1976, Clinical orthopaedics and related research.

[50]  B. Vernon‐roberts,et al.  Healing trabecular microfractures in the bodies of lumbar vertebrae. , 1973, Annals of the rheumatic diseases.

[51]  D W Murray,et al.  In vitro patellofemoral joint force determined by a non-invasive technique. , 1997, Clinical biomechanics.

[52]  H M Toussaint,et al.  Repetitive lifting and spinal shrinkage, effects of age and lifting technique. , 1994, Clinical biomechanics.

[53]  Huub M. Toussaint,et al.  Evaluation of the Probability of Spinal Damage Caused by Sustained Cyclic Compression Loading , 1997, Hum. Factors.

[54]  N. Bogduk,et al.  The Prevalence and Clinical Features of Internal Disc Disruption in Patients With Chronic Low Back Pain , 1995, Spine.

[55]  Adams Ma,et al.  The relevance of torsion to the mechanical derangement of the lumbar spine. , 1981 .

[56]  W. B. Guilford,et al.  The Relative Value of Lumbar Roentgenograms, Metrizamide Myelography, and Discography in the Assessment of Patients with Chronic Low‐back Syndrome , 1987, Spine.

[57]  F. Smith.  Experimental biomechanics of intervertebral disc rupture through a vertebral body. , 1969, Journal of neurosurgery.

[58]  R. Benn,et al.  Vertebral end-plate lesions (Schmorl's nodes) in the dorsolumbar spine. , 1976, Annals of the rheumatic diseases.

[59]  A. Kaigle,et al.  Electromyographic Response of the Porcine Multifidus Musculature After Nerve Stimulation , 1995, Spine.

[60]  D B Chaffin,et al.  A longitudinal study of low-back pain as associated with occupational weight lifting factors. , 1973, American Industrial Hygiene Association journal.

[61]  P. Hudkins,et al.  The Inflammatory Effect of Nucleus Pulposus: A Possible Element in the Pathogenesis of Low-back Pain , 1987, Spine.

[62]  W C Hutton,et al.  Disc space narrowing and the lumbar facet joints. , 1984, The Journal of bone and joint surgery. British volume.

[63]  D G Wilder,et al.  Risk factors in low-back pain. An epidemiological survey. , 1983, The Journal of bone and joint surgery. American volume.

[64]  T. Hansson,et al.  The Bone Mineral Content and Ultimate Compressive Strength of Lumbar Vertebrae , 1980, Spine.

[65]  Pritzker Kp.  Aging and degeneration in the lumbar intervertebral disc. , 1977 .

[66]  B. Vernon‐roberts,et al.  Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. , 1977, Rheumatology and rehabilitation.

[67]  C. Arnoldi.  Intravertebral pressures in patients with lumbar pain. A preliminary communication. , 1972, Acta orthopaedica Scandinavica.

[68]  Lex M. Bouter,et al.  Spinal Radiographic Findings and Nonspecific Low Back Pain: A Systematic Review of Observational Studies , 1997, Spine.

[69]  G Ray,et al.  Microtrauma in the lumbar spine: a cause of low back pain. , 1988, Neurosurgery.

[70]  H. Tsuji,et al.  Effects of Hydrostatic Pressure on Matrix Synthesis and Matrix Metalloproteinase Production in the Human Lumbar Intervertebral Disc , 1997, Spine.

[71]  S. Kumar,et al.  Cumulative Load as a Risk Factor for Back Pain , 1990, Spine.

[72]  A. Begg.  Nuclear herniations of the intervertebral disc; their radiological manifestations and significance. , 1954, The Journal of bone and joint surgery. British volume.

[73]  J. Troup,et al.  Plain Radiographic, Discographic, and Direct Observations of Schmorl's Nodes in the Thoracolumbar Junctional Region of the Cadaveric Spine , 1987, Spine.

[74]  H. Vanharanta,et al.  Height changes among chronic low back pain patients during intense physical exercise , 1997, Scandinavian Journal of Medicine & Science in Sports.

[75]  R. Norman,et al.  Disability Resulting From Occupational Low Back Pain: Part II: What Do We Know About Secondary Prevention? A Review of the Scientific Evidence on Prevention After Disability Begins , 1996, Spine.

[76]  D A Stubbs,et al.  Back pain in the nursing profession. I. Epidemiology and pilot methodology. , 1983, Ergonomics.

[77]  Mw Van Tulder.  Spinal radiographic findings and nonspecific low back pain , 1997 .

[78]  T. Keller,et al.  Mechanical behavior of the human lumbar spine. II. Fatigue strength during dynamic compressive loading , 1987, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[79]  D. Resnick,et al.  Intravertebral disk herniations: cartilaginous (Schmorl's) nodes. , 1978, Radiology.

[80]  I. Kingma,et al.  Finite element aided tracking of signal intensity changes in deforming intervertebral disc tissue. , 1998, Magnetic resonance imaging.

[81]  R. G. Johnson,et al.  The Relationship of Pain Provocation to Lumbar Disc Deterioration as Seen by CT/Discography , 1987, Spine.

[82]  G. Waddell,et al.  1987 Volvo Award in Clinical Sciences: A New Clinical Model for the Treatment of Low-Back Pain , 1987, Spine.

[83]  T. Hansson,et al.  The Amount of Bone Mineral and Schmorl's Nodes in Lumbar Vertebrae , 1983, Spine.

[84]  J. Weinstein,et al.  The Lumbar Spine , 1990 .