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. 2018 Dec;4(4):151-160.
doi: 10.1007/s40610-018-0105-y. Epub 2018 Sep 20.

Contribution of the endplates to disc degeneration

Aaron J Fields  1 , Alexander Ballatori  1 , Ellen C Liebenberg  1 , Jeffrey C Lotz  1
Affiliations

Contribution of the endplates to disc degeneration

Aaron J Fields et al. Curr Mol Biol Rep. 2018 Dec.

Abstract

Purpose of review: The endplates form the interface between the rigid vertebral bodies and compliant intervertebral discs. Proper endplate function involves a balance between conflicting biomechanical and nutritional demands. This review summarizes recent data that highlight the importance of proper endplate function and the relationships between endplate dysfunction, adjacent disc degeneration, and axial low back pain.

Recent findings: Changes to endplate morphology and composition that impair its permeability associate with disc degeneration. Endplate damage also associates with disc degeneration, and the progression of degeneration may be accelerated and the chronicity of symptoms heightened when damage coincides with evidence of adjacent bone marrow lesions.

Summary: The endplate plays a key role in the development of disc degeneration and low back pain. Clarification of the mechanisms governing endplate degeneration and developments in clinical imaging that enable precise evaluation of endplate function and dysfunction will distinguish the correlative vs. causative nature of endplate damage and motivate new treatments that target pathologic endplate function.

Keywords: Modic change; back pain; endplate; endplate bone marrow lesion; intervertebral disc degeneration; spine.

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Conflict of interest statement

Conflict of Interest Alexander Ballatori and Ellen C. Liebenberg each declare no potential conflicts of interest. Jeffrey C. Lotz is co-founder and has shares in Relievant Mesystems.

Figures

Figure 1.
Figure 1.
(A) In a healthy spine, the endplate, including cartilage and bone, forms a continuous interface between the disc and vertebral body. Structural defects and degenerative changes may include: (B) tidemark avulsions of the outer annulus at the vertebral rim; (C) erosions of the cartilage endplate and/or underlying endplate bone; (D) changes to the cartilage matrix, including calcification, dehydration, and loss of matrix protein homeostasis; (E) fissuring and fracture of the bony endplate; (F) herniation of the nucleus pulposus into the underlying trabecular bone and subsequent depressurization of the disc with inward bulging of the annulus; (G) sclerosis or thickening of the bony endplate (note: samples are 8.25 mm diameter); (H) avulsion of the cartilage endplate at the inner annulus-endplate junction with fibrovascular bone marrow lesion.
See this image and copyright information in PMC

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