Cartilaginous endplates: A comprehensive review on a neglected structure in intervertebral disc research

Abstract

The cartilaginous endplates (CEP) are key components of the intervertebral disc (IVD) necessary for sustaining the nutrition of the disc while distributing mechanical loads and preventing the disc from bulging into the adjacent vertebral body. The size, shape, and composition of the CEP are essential in maintaining its function, and degeneration of the CEP is considered a contributor to early IVD degeneration. In addition, the CEP is implicated in Modic changes, which are often associated with low back pain. This review aims to tackle the current knowledge of the CEP regarding its structure, composition, permeability, and mechanical role in a healthy disc, how they change with degeneration, and how they connect to IVD degeneration and low back pain. Additionally, the authors suggest a standardized naming convention regarding the CEP and bony endplate and suggest avoiding the term vertebral endplate. Currently, there is limited data on the CEP itself as reported data is often a combination of CEP and bony endplate, or the CEP is considered as articular cartilage. However, it is clear the CEP is a unique tissue type that differs from articular cartilage, bony endplate, and other IVD tissues. Thus, future research should investigate the CEP separately to fully understand its role in healthy and degenerated IVDs. Further, most IVD regeneration therapies in development failed to address, or even considered the CEP, despite its key role in nutrition and mechanical stability within the IVD. Thus, the CEP should be considered and potentially targeted for future sustainable treatments.

Bioprinting of gelatin-based materials for orthopedic application

“…As a result, any materials intended for articular cartilage regeneration via the bio-printing method should possess comparable attributes. Furthermore, the intervertebral disc (IVD) structure is more complicated than the articular cartilage structure ( Crump et al, 2023 ; She et al, 2023 ). The IVD annulus pulposus concentric fibrous layers encircled the nucleus pulposus, which carries the axial compressive loads.…”

Advancing basic and preclinical spine research: Highlights from the ORS PSRS 6th International Spine Research Symposium

“…The cartilaginous endplates perhaps more than any other disc substructure illustrate the central role of biomechanical and biological interplay in disc function, both facilitating pressurization by restricting fluid flow and regulating the passage of nutrients to cells within the avascular nucleus pulposus. In a comprehensive review, Crump et al outline the critical role of the cartilaginous endplates in disc health and degeneration 4 …”

Expression of toll-like receptors in cartilage endplates cells: a role of toll-like receptor 2 in pro-inflammatory and -catabolic gene expression

“…Its intactness is critical for the health of the disc [1], [2]. CEP degeneration has been associated with chronic low back pain (CLBP) [3], disc degeneration (DD) [4], [5], [6], [7], [8], and Modic changes (MC) [9], [10], [11]. Yet, the mechanisms linking CEP degeneration to DD and MC remain unclear.…”