Classification of Schmorl's nodes of the lumbar spine and association with disc degeneration: a large-scale population-based MRI study D. Samartzis,

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Classification of Schmorl's nodes of the lumbar spine and association with disc degeneration: a large-scale population-based MRI study D. Samartzis, F.P.S. Mok, J. Karppinen, D.Y.T. Fong, K.D.K. Luk, K.M.C. Cheung Osteoarthritis and Cartilage Volume 24, Issue 10, Pages 1753-1760 (October 2016) DOI: 10.1016/j.joca.2016.04.020 Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 MRI showing the classification of shapes according to the morphological presentation of SN. a) shows the indented shape SN at caudal endplate (EP) of L2 disc level; b) shows the sharp shape SN at caudal EP of L2 disc level; c) shows the round shape SN at caudal EP of L2 disc level; d) shows the rectangular shape SN at rostral EP of L2 disc level; and e) shows the irregular shape SN at caudal EP of T12–L1 disc level and both rostral and caudal EP of L3 disc level. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Bar chart showing the percent prevalence of the endplate (EP) involvement of SN per disc levels. Percent values are illustrated in labels. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 Bar chart showing the percent prevalence of the relative size of SN per lumbar disc level. A yellow dashed line is inserted to illustrate the reverse pattern of the SN size across the lumbar disc levels that prevalence of small SN peaked at L3. Percent values are illustrated in labels. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 4 Bar charts showing the percent prevalence of the location of endplate zone of SN per lumbar disc level. A yellow dashed line is inserted to illustrate the reverse pattern of the relative location of SN across the lumbar disc levels that prevalence of middle located SN peaked at L3. A green dotted line is inserted to illustrate the decrease prevalence in anterior and anterior-middle located SN from the upper to the lower lumbar disc levels. Percent values are illustrated in labels. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 5 Figure showing the linkage pattern between SN characteristics and endplate (EP) clusters as indicated by color arrows pointing to the corresponding clusters. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 6 Graph showing the multivariable ordinal logistic regression model showing the odds ratio (OR) associated with the increase in DD severity with the presence of “Typical SN” and “Atypical SN” at both rostral and caudal endplates. Model adjusted for gender, age, BMI, smoking status, presence of disc displacement, and HIZ. (Note: If the range of 95% CI of the OR value does not cross the value of 1 [the green dashed line], the association is significant). Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 1 Endplate involvement of SN on MRI: a) rostral, b) caudal, and c) both. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 2 Size of the SN on MRI: a) less than one-third or b) greater one-third but less than two-thirds endplate involvement, and c) greater two-thirds endplate involvement. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions

Fig. 3 SN a) with no vertebral marrow changes or b) with vertebral marrow changes on MRI. Osteoarthritis and Cartilage 2016 24, 1753-1760DOI: (10.1016/j.joca.2016.04.020) Copyright © 2016 Osteoarthritis Research Society International Terms and Conditions