The Anatomy of Vertebral Endplates

Vertebral endplates are located between vertebrae (bones of the spine) and intervertebral discs (the gel-filled structures that protect and cushion the vertebrae). They consist of a layer of cartilage and a layer of porous bone.

Vertebral endplates serve as a layer of protection between the hard, bony vertebrae and the softer, more delicate discs. They also are the passageway through which blood and nutrients make their way to the discs. The injury or degeneration of the endplates in the lumbar (lower) spine may cause certain types of back pain.

Anatomy of Vertebral Endplates

Each vertebral endplate consists of two distinct layers:

• The cartilaginous endplate: This layer connects to vertebral discs. Depending on where on the spine it is located, the cartilaginous endplate can range in size from 0.1 millimeters (mm) to 2.0 mm thick.
• The bony endplate: This layer of porous bone attaches to the vertebrae and is between 0.2 mm and 0.8 mm thick.

The diameter and shape of each endplate correspond to the diameter and shape of the vertebra it is attached to. Endplates in the cervical (neck) spine will be smaller, while endplates in the lumbar spine will be larger.

In young adults, vertebral endplates are dense, thick, and curved. Over time, they become thinner, flatter, and more brittle due to the stress of gravity and your body weight,

Function of Vertebral Endplates

The lower vertebrae of the spine take on the weight of the upper body and are therefore subject to considerable stress.

As the intermediary layer between the bones and discs, the vertebral endplates provide strength and stability to help prevent fractures and protect the delicate intervertebral discs.

Because of their porousness, they also serve as the vehicle through which blood and nutrients flow from capillaries in the bone to cells in the discs. This is important because intervertebral discs do not receive their own blood supply as the vertebrae do.

Causes

Endplates are vulnerable to damage when compressed by an injury or an inactive lifestyle. When endplates begin to deteriorate, inflammation increases and lesions start to develop on the spine.

Studies have found that the development of lesions on endplates in the lumbar spine is associated with increasing levels of low back pain. In its advanced stages, endplate degeneration is called endplate sclerosis (sclerosis meaning "hardening").

There are two common conditions associated with vertebral endplate failure and the onset of endplate sclerosis:

• Disc herniation: This is the bulging of an intervertebral disc, which causes pain by compressing spinal nerves. This is a form of degenerative disc disease associated with spinal osteoarthritis ("wear-and-tear arthritis" of the spine)
• Spinal stenosis: This is the narrowing of the spinal canal that houses the spinal cord (due to conditions like spinal arthritis and other causes). Pain results from compressing the spinal cord and/or spinal root nerves.

Diagnosis

Endplate damage can be difficult to detect, even with diagnostic imaging. For this reason, healthcare providers often overlook this when investigating the cause of low back pain.

With that said, magnetic resonance imaging (MRI) may be able to detect changes in the bone layer of the endplate, known as Modic changes. MRIs used powerful magnetic and radio waves to create highly detailed images of soft tissues and, by doing so, detect problems like disc herniation and spinal stenosis.

When a healthcare provider detects Modic changes, they may be able to identify a link between these changes and certain types of low back pain.

Treatment

The degeneration of the vertebrae of the spine—in particular, endplate damage—should be treated in a progressive fashion, starting with less invasive interventions and moving up to more invasive alternatives if initial treatments don't give the desired results.

Physical Therapy

It is no surprise that physical therapy is one of the few interventions that has shown benefits in treating chronic back pain. Improving back functionality is key in order to overcoming the pain and limitations that come from endplate degeneration.

A thorough course of physical therapy must be the first step on the road to recovery from the pain associated with vertebral endplate failure.

Weight Loss

Ultimately this is an issue of gravity: The spine is in charge of receiving our body weight. And people who are overweight will have faster and more profound degeneration of their vertebral endplates. It is never too late to try and lose weight.

Marginal weight losses of 5% to 10% of body weight can have a dramatic impact on the pain that stems from vertebral endplate failure.

Medications

Taking medications like Tylenol (acetaminophen) or nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) on schedule—with the guidance of a doctor—can be useful for issues like chronic back pain.

Other medications for chronic pain for this type of ailment include:

• Neurontin (gabapentin)
• Lyrica (pregabalin)
• Cymbalta (duloxetine)
• Tricyclic antidepressants
• Opioids like Oxycontin (oxycodone)

Surgery

When endplate degeneration advances to the point of causing severe pain and debilitation, treatment typically involves lumbar spinal fusion surgery.

This procedure involves stimulating the growth of new bone between two vertebrae. Sometimes the disc between them as well as the endplate are removed to allow the vertebrae to fuse.