Symptoms of Vertebrogenic Pain

For patients seeking an accurate diagnosis, it is a good idea to specifically track your symptoms so that you can assist in your diagnosis and deciding on your treatment program.

Common Symptoms of Vertebrogenic Pain

Vertebral endplate pain can range from mild to severe, it may be felt as a chronic low level of pain with flareups of intense pain.

Most people with vertebrogenic pain have one or a combination of the following symptoms¹Sayed D, Naidu RK, Patel KV, et al. Best Practice Guidelines on the Diagnosis and Treatment of Vertebrogenic Pain with Basivertebral Nerve Ablation from the American Society of Pain and Neuroscience. J Pain Res. 2022;15:2801-2819. Published 2022 Sep 14. doi:1 0.2147/JPR.S378544:

• Midline low back pain: A deep, aching, or throbbing pain in the lower back localized around the affected spinal segment(s) in the lower back
• Stiffness: The lower back may feel stiff, especially after a prolonged period of sitting or right after getting out of bed in the morning
• Worse at night: Many people report pain that is worse in the morning, and/or during the night
• Activity-related flare-ups: The pain worsens with spinal movements that move or increase loads on the damaged endplate, such as: 
  • Sitting for prolonged periods of time
  • Bending forward
  • Changing position from sitting to standing
  • Standing for extended periods of time
  • Sports that stress the area, such as running, cycling, lifting weights, or any type of jumping, hopping or twisting
• Rest: Pain tends to subside with rest, especially when in a supported position that reduces stress on the lower back. For example, sitting in a reclining chair or in an adjustable bed with the upper body on an incline and knees propped up. However, if the nerves have become highly sensitized the pain may continue even while at rest.

It is not uncommon to have more than one problem that is contributing to one’s back pain. This is why it's important to see an appropriately trained and qualified spine specialist for a thorough examination and, if indicated, diagnostic testing.

How Vertebral Endplate Pain is Diagnosed

The gold standard for diagnosing vertebrogenic pain caused by damaged endplates is an MRI scan.

When the findings of the MRI scan correlate to the results of the patient’s medical history and physical exam, vertebrogenic pain may be diagnosed.

3-Step diagnostic process to identify vertebrogenic pain:

1. Patient medical history: the patient’s medical history is reviewed, with a particular focus on the specific symptoms.
2. Physical exam: the doctor conducts a physical exam, primarily to evaluate for other issues that mimic vertebrogenic pain.
3. MRI scan. An MRI scan is done to check for damage to the vertebral endplates in the lower spine.

The distinctive patterns visible on damaged endplates are called Modic changes.

Damaged endplates are diagnosed in 3 categories²Koreckij T, Kreiner S, Khalil JG, et al. Prospective, randomized, multicenter study of intraosseous basivertebral nerve ablation for the treatment of chronic low back pain: 24-Month treatment arm results. N Am Spine Soc J. 2021;8:100089. Published 2021 Oct 26. doi:10.1016/j.xnsj.2021.100089, ³Viswanathan VK, Shetty AP, Rajasekaran S. Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain. J Clin Orthop Trauma. 2020;11(5):761-769. doi:10.1016/j.jcot.2020.06.025:

• Modic type 1 changes –inflammation and swelling of the bone marrow adjacent to the endplates.
• Modic type 2 changes –fat deposits on the endplate. Type 2 usually indicates chronic degeneration of spinal discs.
• Modic type 3 changes –hardened and thickened bone marrow (sclerosis) adjacent to the endplates. Type 3 typically indicates advanced degeneration of spinal discs.

Modic type 1 and 2 changes are associated with vertebrogenic low back pain. These changes are most common in the L3-L4, L4-L5, and L5-S1 spinal levels³Viswanathan VK, Shetty AP, Rajasekaran S. Modic changes - An evidence-based, narrative review on its patho-physiology, clinical significance and role in chronic low back pain. J Clin Orthop Trauma. 2020;11(5):761-769. doi:10.1016/j.jcot.2020.06.025, ⁴Chen, Y., Bao, J., Yan, Q. et al. Distribution of Modic changes in patients with low back pain and its related factors. Eur J Med Res 24, 34 (2019). doi:10.1186/s40001-019-0393-6, ⁵Wei B, Wu H. Study of the Distribution of Lumbar Modic Changes in Patients with Low Back Pain and Correlation with Lumbar Degeneration Diseases. J Pain Res. 2023;16:3725-3733. Published 2023 Nov 6. doi:10.2147/JPR.S430792, ⁶Tieppo Francio V, Sayed D. Basivertebral Nerve Ablation. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK572127/.

Other radiographic imaging tools such as x-rays are generally not useful in visualizing endplate damage. In some cases, increased degenerative endplate changes may be visible on a computed tomography (CT) scan.

While low back pain is common, it is often challenging to diagnose the underlying cause of the pain. However, an accurate diagnosis for the cause of pain is important to guide the appropriate treatment approach.