~ 603 ~ International Journal of Orthopaedics Sciences 2021; 7(4): 603-605 E-ISSN: 2395-1958 P-ISSN: 2706-6630 IJOS 2021; 7(4): 603-605 © 2021 IJOS www.orthopaper.com Received: 02-08-2021 Accepted: 03-09-2021 Sudhir Kumar Mahapatra Assistant Professor, Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India Madan Mohan Sahoo Professor, Department of Orthopaedics, PRM Medical College, Rangamatia, Baripada, Odisha, India Udit Sourav Sahoo Assistant Professor, Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India Sheetal Kaur Assistant Professor, Department of Radiodiagnosis, SCB Medical College, Cuttack, Odisha, India Manoranjan Mohapatra Associate Professor, KIMS Medical College, Patia, Bhubaneswar, Odisha, India Corresponding Author: Udit Sourav Sahoo Assistant Professor, Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India Evaluation of asymptomatic lumbar disc herniation and endplate failure in general population and their significance in development of low backache Sudhir Kumar Mahapatra, Madan Mohan Sahoo, Udit Sourav Sahoo, Sheetal Kaur and Manoranjan Mohapatra DOI: https://doi.org/10.22271/ortho.2021.v7.i4h.2937 Abstract Introduction: Despite being the most common cause of low back pain, there are wide variations in the pathogenesis and management of lumbar disc herniation (LDH). Previously the nucleus pulposus was being implicated for most of the symptoms, but recent papers propose the endplate failure (EPF) as the most important component of symptomatic LDH. However considering the abundance of the asymptomatic LDH in normal population, it is important to study the association of endplate failure in general population to understand it’s contribution in symptomatic LDH. Aim: To evaluate the incidence of asymptomatic LDH and EPF in normal population and note development of any low back pain in them. Material and Methods: Adult patients presenting outdoor with complains other than present or past history of low backache were evaluated clinically and radiologically [x-ray, CT scan, MRI scan including the fat suppressed 3D fast spoiled gradient sequences (3DFSPGR)] to note status of lumbar disc and endplate. They were then, prospectively followed up for 3 years for any occurrence of backache. Results: Twenty volunteers (13 males, 7 females) were studies from age 19-50 years (mean 33.6±10.3). Six volunteers (30%) had desiccation of one or more lumbar disc and 8 volunteers (40%) had LDH at one or more levels. However all of the LDH were broad based disc bulge. Three volunteers had cartilaginous EPF and 1 had bony EPF. None of the EPFs were associated with disc desiccation, but 2 were associated with LDH. The presence of disc desiccations and LDH were significantly correlated to the increasing age but the EPF had no such age correlation. Subsequently 2 volunteers developed low backache. Conclusion: Asymptomatic disc desiccation and lumbar disc bulge is fairly common. Their mere presence may not be the cause of the low backache and should be carefully considered for any surgical planning. However presence bony EPF is rare and may have some significance in development of symptomatic LDH. Keywords: Lumbar disc herniation, bony endplate failure, cartilaginous endplate failure Introduction Lumbar disc herniation (LDH) is the most common cause of low backache affecting 1-5 per 1000 population per year [1] . Despite of that, there is wide variation regarding the pathogenesis and management [2-4] . The discogenic back pain is multifactorial in origin arising from mechanical compression, neurophysiological changes, ischemia, inflammatory and/or immunologic mechanisms [5, 6] . Previously the nucleus pulposus was being implicated for most of the symptoms, but now the role of other structures are increasingly being recognized [2, 3, 5-9] . The endplate lies between the vertebral body and intervertebral disc and provides strength and nutrition to the disc [10-12] . But its junctional location predispose it to mechanical failure and early degeneration [13] . Though some previous cadaveric studies and 2 in vivo study have highlighted the role of endplate failure (EPF) in LDH none of them have delineated the extent of association and natural progression from endplate failure to symptomatic LDH. Described its significance in clinical symptomatology [5-7, 14, 15, 16] . Of these 2 in vivo studies while Rajashekaran et al. have not mentioned anything regarding the cartilaginous EPF. Sahoo et al. have noted a very high incidence of asymptomatic cartilaginous EPF but have not discussed its implications on LDH [16] .