Contribution of the Endplates to Disc Degeneration

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.

Nutrient supply and nucleus pulposus cell function: effects of the transport properties of the cartilage endplate and potential implications for intradiscal biologic therapy

“…Cells inside the nucleus pulposus (NP) mainly rely on nutrient transport to and from the vertebral capillaries, 9,10 which can be compromised by several factors. The vertebral capillaries penetrate pores in the bony endplate and terminate adjacent to the cartilage endplate (CEP) 11,12 (CEP; Fig. 1).…”

Matrix modification for enhancing the transport properties of the human cartilage endplate to improve disc nutrition

“…For example, nutrients entering the disc and exiting metabolites must diffuse through the cartilage endplates (CEP), and diffusion could be hindered by age- or degeneration-related changes to the CEP matrix, including dehydration [14], mineralization [15–17], and fibrosis [14, 17, 18]. In addition to altering the mechanical functionality of the CEP [19], which is also physiologically important [20, 21], these matrix changes impact CEP biotransport functionality too. Specifically, dehydration prevents solutes from diffusing freely within the CEP; and increased deposition of proteoglycan, collagen, and mineral limits the amount of pore space available to solutes [22, 23].…”

Effects of Endplate Healing Morphology on Intervertebral Disc Degeneration after Pedicle Screw Fixation for Thoracolumbar Fractures

“…The endplate is a layered composite material composed of semiporous thickened cancellous bone (0.6-1 mm) and transparent cartilage (0.2-0.8 mm) [8]. Because of its unique anatomical morphology and material properties, the cartilage endplate has two important functions: biological transport and stress conduction [9]. On the one hand, the intervertebral disc is the largest avascular structure in the human body, and the nucleus pulposus cells almost completely depend on the nutrients provided by the capillary bed of the vertebral body near the endplate.…”