J Korean Orthop Assoc.  2021 Aug;56(4):283-293. 10.4055/jkoa.2021.56.4.283.

Current Concepts of Degenerative Disc Disease -A Significance of Endplate-

• Soh J
• Jang HD
• Shin BJ

• KMID: 2519119
• DOI: http://doi.org/10.4055/jkoa.2021.56.4.283

Abstract

Degenerative disc disease has traditionally been thought of as low back pain caused by changes in the nucleus pulposus and annulus fibrous, in recent studies, however, changes in the upper and lower endplates cause degeneration of the disc, resulting in mechanical pressure, inflammatory reactions and low back pain. Recently, the bone marrow of the vertebral body-endplate-nucleus pulposus and annulus fibrous were considered as a single unit, and the relationship was explained. Once the endplate is damaged, it eventually aggravates the degeneration of the bone marrow, nucleus pulposus, and annulus fibrosus. In this process, the compression force of the annulus fibrosus increases, and an inflammatory reaction occurs due to inflammatory mediators. Hence, the sinuvertebral nerves and the basivertebral nerves are stimulated to cause back pain. If these changes become chronic, degenerative changes such as Modic changes occur in the bone marrow in the vertebrae. Finally, in the case of degenerative intervertebral disc disease, the bone marrow of the vertebral body-endplate-nucleus pulposus and annulus fibrous need to be considered as a single unit. Therefore, when treating patients with chronic low back pain, it is necessary to consider the changes in the nucleus pulposus and annulus fibrosus and a lesion of the endplate.

Keyword

lumbar; endplate; degenerative disc disease