The Anatomy of Vertebral End Plates

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Vertebral endplates are located between vertebrae (bones of the spine) and intervertebral discs (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 discs. Injury to the endplates or degeneration of the endplates in the lumbar (lower) spine are thought to be associated with some types of back pain.

X-ray image of arthritic spine
CNRI / Science Photo Library / Getty Images

Anatomy

Each vertebral endplate has two distinct layers:

  • The cartilaginous endplate. This layer connects to vertebral discs. Depending on where on the spine it's located, it can range in size from 0.1 millimeter (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.

The diameter and shape of each endplate corresponds to that of the vertebra it's attached to. Endplates in the cervical (neck) area will be smaller, while endplates in the lumbar area (low back) will be larger.

In young adults, vertebral endplates are dense, thick, and well-curved. Over time, due to the pressure put on them from the weight of the body and the pull of gravity, they become thinner, flatter, and brittle.

Function

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 endplates provide strength and stability to help prevent vertebral fracture and to protect the delicate discs.

Because of their porousness, they also serve as the medium 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.

Associated Conditions

Endplates are vulnerable and easily damaged when compressed by injury or by a long-term sedentary lifestyle. When endplates begin to deteriorate, inflammation increases and lesions can develop.

Studies have found evidence that such lesions on endplates in the lumbar region of the back are associated with low back pain. In its advanced stages, endplate degeneration is called endplate sclerosis.

Endplate damage can be difficult to detect, even with diagnostic imaging. For this reason, doctors may not consider it when evaluating patients with back pain.

However, magnetic resonance imaging (MRI) may be able to detect Modic changes, or changes in the bone layer of the endplate, that could be associated with degenerative disc disease and chronic low back pain. When doctors observe Modic changes, they may be able to identify a link between them and certain types of low back pain.

Treatment

The degeneration of the vertebra 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 expected results.

Physical Therapy

It is no surprise that physical therapy is one of the few interventions that has shown benefit in chronic back pain. Improving back functionality is key in order to overcome the pain and limitations that come from endplate degeneration. A thorough course of physical therapy must be the first step in the road to recovery from spinal degenerative disease associated pain.

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 end plates. 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 pain that stems from degenerative spine disease.

Medications

Taking medications like Tylenol or NSAIDS (i.e. Advil) on schedule—with the guidance of a doctor—can be useful for issues like chronic back pain. Other medications for chronic pain include gabapentin, Lyrica (pregabalin), Cymbalta (duloxetine) and a family of medications called tricyclic antidepressants. Opioids (i.e. Oxycodone, Oxycontin) have been frequently used for this type of ailment, however their risk usually warns against the little long-term benefit they provide.

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.

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