Elsevier

Medical Hypotheses

Volume 53, Issue 3, September 1999, Pages 246-252
Medical Hypotheses

Regular Article
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

https://doi.org/10.1054/mehy.1998.0754Get rights and content

Abstract

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 everday life. Furthermore, epidemiological findings and the natural history of low back pain appear to be in line with the proposed hypothesis.

References (93)

  • F. Biering-Sorensen

    A prospective study of low back pain in a general population. L. Occurrence, recurrence and aetiology

    Scand J Rehab Med

    (1983)
  • H.A. Valkenburg et al.

    The epidemiology of low back pain

  • G. Wickstrom

    Symptoms and signs of degenerative back disease in concrete reinforcement workers

    Scand J Work, Environ Health

    (1978)
  • H. Riihimäki

    Back pain and heavy physical work: a comparative study of concrete reinforcement workers and maintenance house painters

    Br J Indus Med

    (1985)
  • B.W. Koes et al.

    The prognosis of low back pain in general practice

    Spine

    (1997)
  • G. Waddell

    A new clinical model for the treatment of low-back pain

    Spine

    (1987)
  • J.W. Frank et al.

    Disability resulting from low back pain. I. What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins

    Spine

    (1996)
  • J.W. Frank et al.

    Disability resulting from occupational low back pain. II. What do we know about secondary prevention? A review of the scientific evidence on prevention after disability begins

    Spine

    (1996)
  • A.C. Schwarzer et al.

    The relative contributions of the disc and zygapophyseal joint in chronic low-back-pain

    Spine

    (1994)
  • A.C. Schwarzer et al.

    The sacroiliac joint in chronic low-back-pain

    Spine

    (1995)
  • M. Van Tulder et al.

    Spinal radiographic findings and nonspecific low back pain

    Spine

    (1997)
  • H. Vanharanta et al.

    The relationship of pain provocation to lumbar disc deterioration as seen by CT/discography

    Spine

    (1987)
  • S.A. Grubb et al.

    The relative value of lumbar roentgenogram, metrizamide, myelography and discography in the assessment of patients with chronic lowback syndrome

    Spine

    (1987)
  • T.R. Walsh et al.

    Lumbar discography in normal subjects. A controlled prospective study

    J Bone Joint Surg

    (1990)
  • A.C. Schwarzer et al.

    The prevalence and clinical features of internal disc disruption in patients with chronic low back pain

    Spine

    (1995)
  • D.D. McNally et al.

    In vivo stress measurement can predict pain on discography

    Spine

    (1996)
  • C.C. Arnoldi

    Intravertebral pressure in patients with lumbar pain. A preliminary communication

    Acta Orthop Scand

    (1972)
  • M.R. Moore et al.

    Relationship between vertebral intraosseus pressure, pH, pO2, pCO2, and magnetic resonance imaging signal inhomogeneity inpatients with back pain. An in vivo study

    Spine

    (1991)
  • S.D. Kuslich et al.

    What tissues are responsible for low back pain and sciatica? Latest results of an ongoing investigation of tissue sensitivity in humans undergoing operations on the lumbar spine using local anesthesia

  • A. Burdorf

    Assessment of postrual load on the back in occupational epidemiology (PhD)

    (1992)
  • N. Boos et al.

    The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations

    Spine

    (1995)
  • K. Hsu et al.

    Painful lumbar end-plate disruptions: a significant discographic finding

    Spine

    (1988)
  • K. Takahashi et al.

    A large painful Scmorl's node: a case report

    J Spinal Dis

    (1994)
  • D.M. Smith

    Acute back pain associated with a calcified Schmorl's node. A case report

    Clin Orthop Rel Res

    (1976)
  • I.W. McCall et al.

    Acute traumatic intraosseous disc herniation

    Spine

    (1985)
  • N. Yoganandan et al.

    Microtrauma in the lumbar spine: a cause of low back pain

    Neurosurgery

    (1988)
  • F.P. Smith

    Experimental biomechanics of intervertebral disc rupture through a vertebral body

    J Neurosurg

    (1969)
  • T. Hansson et al.

    The relation between bone mineral content, experimental compression fractures and disc degeneration

    Spine

    (1981)
  • N. Yoganandan

    Correlation of microtrauma in the lumbar spine with intraosseus pressures

    Spine

    (1994)
  • N. Yoganandan et al.

    Intravertebral pressure changes caused by spinal microtrauma

    Neurosurgery

    (1994)
  • A.C. Begg

    Nuclear herniations of the intervertebral disc

    J Bone Joint Surg (Br)

    (1954)
  • D. Resnick et al.

    Intravertebral disk herniations: cartilaginous (Schmorl's) nodes

    Radiology

    (1978)
  • R.C. Hilton et al.

    Vertebral end-plate lesions (Scmorl's nodes) in the dorsolumbar spine

    Ann Rheum Dis

    (1976)
  • A. Malmivaara et al.

    Plain radiographic, discographic, direct observations of Schmorl's nodes in the thoracolumbar junctional region of the cadaveric spine

    Spine

    (1987)
  • K. Takahashi et al.

    Schmorl's nodes and low-back pain. Analysis of magnetic resonance imaging findings in symptomatic and asymptomatic individuals

    Eur Spine J

    (1995)
  • M.A. Adams et al.

    Abnormal stress concentrations in lumbar intervertebral discs following damage to the vertebral bodies: a cause of disc failure

    Eur Spine J

    (1993)
  • Cited by (86)

    • Intervertebral disc degeneration

      2022, Spine Phenotypes
    • Obesity could be associated with poor paraspinal muscle quality at upper lumbar levels and degenerated spine at lower lumbar levels: Is this a domino effect?

      2021, Journal of Clinical Neuroscience
      Citation Excerpt :

      2) IVDD or disc herniation may increase shear forces on the vertebral end-plates due to the loss of the nucleus pulposus. Increased axial and torsional stresses could cause micro-fractures in the vertebral end-plates [24–26]. Consistently, we also suggest that degenerated intervertebral discs at L4-L5 level might transfer the shear forces one level below to L5-S1 vertebral end-plates.

    View all citing articles on Scopus
    View full text