Prevalence and clinical relevance of endplate junction failure in lumbar disc herniation: a post-hoc subgroup analysis of 5-year follow-up prospective data
In brief
Endplate junction failure reduces 5-year recurrence to 5% versus 14%
In a post-hoc analysis of 135 patients who had minimally invasive discectomy, 70% showed endplate junction failure (EPJF). Although EPJF patients reported slightly worse disability and pain at six months, their outcomes equalized by five years and they experienced a markedly lower symptomatic recurrence rate (4.7% vs 14.3%). The finding suggests EPJF may be a favorable prognostic sign for long-term durability, but its short-term impact warrants attention.
- Journal
- European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society (Q1)
- Published
- 7 August 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Tianwei He, Shangfu Li, Lijun Huang, Jianwen Dong, Lei He, Zhongyu Liu, et al.
- PMID
- 42566043
- DOI
- 10.1007/s00586-026-10270-2
Why clinicians should know about it
- Picked for Spine Surgery (top studies of the week, 11 October 2026): Endplate junction failure impacts short-term outcomes after minimally invasive discectomy
Abstract
OBJECTIVE: This study conducted a post-hoc exploratory subgroup analysis of 5-year follow-up data from a randomized controlled trial (RCT) to clarify the prevalence and clinical relevance of endplate junction failure (EPJF) in patients with lumbar disc herniation (LDH). METHODS: Patients diagnosed with LDH who underwent minimally invasive discectomy in our RCT were included. Based on MRI findings, operated discs with type 1 herniation (evidencing EPJF) were assigned to Group 1, and those with type 2 herniation (without EPJF) to Group 2. Demographic characteristics, radiological parameters, and clinical outcomes (assessed via patient-reported outcome measures [PROMs]) were compared between the two groups. RESULTS: A total of 135 patients (69.2%) were classified as type 1 herniation with EPJF. EPJF predominantly involved both endplates (48.1%), followed by the lower endplate junction (42.2%). Sixty discs (30.8%) with intact endplates without junction failure were classified as type 2 herniation. Both groups showed significant improvements in all PROMs at short-term (6 months) and long-term (5 years) follow-ups after surgery. Although Group 1 exhibited worse short-term Oswestry Disability Index (ODI) scores, European Quality of Life-5 Dimensions (EQ-5D) scores, and visual analog scale for back pain (VAS-back) (P < 0.05), long-term PROMs were comparable between the two groups. The 5-year cumulative symptomatic recurrence rate was significantly lower in Group 1 (4.7%) than in Group 2 (14.3%) (P = 0.031). CONCLUSIONS: This study reinforces evidence that EPJF is common in surgical LDH patients. While EPJF negatively affects short-term clinical outcomes, long-term outcomes are satisfactory with a lower symptomatic recurrence rate. CLINICAL TRIAL: This trial was registered at ClinicalTrials.gov on November 14, 2013 (registration number: NCT01997086; https://clinicaltrials.gov/ct2/show/NCT01997086).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.