Cartilaginous endplates: A comprehensive review on a neglected structure in intervertebral disc research
Katherine B. Crump,
Ahmad Alminnawi,
Paola Bermudez‐Lekerika,
Roger Compte,
Francesco Gualdi,
Terence McSweeney,
Estefano Muñoz‐Moya,
Andrea Nüesch,
Liesbet Geris,
Stefan Dudli,
Jaro Karppinen,
Jérôme Noailly,
Christine Le Maitre,
Benjamin Gantenbein
Affiliations
Katherine B. Crump
Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty University of Bern Bern Switzerland
Ahmad Alminnawi
GIGA In Silico Medicine University of Liège Liège Belgium
Paola Bermudez‐Lekerika
Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty University of Bern Bern Switzerland
Roger Compte
Twin Research & Genetic Epidemiology St. Thomas' Hospital, King's College London London UK
Francesco Gualdi
Institut Hospital del Mar d'Investigacions Mèdiques (IMIM) Barcelona Spain
Terence McSweeney
Research Unit of Health Sciences and Technology University of Oulu Oulu Finland
Estefano Muñoz‐Moya
BCN MedTech, Department of Information and Communication Technologies Universitat Pompeu Fabra Barcelona Spain
Andrea Nüesch
Division of Clinical Medicine, School of Medicine and Population Health University of Sheffield Sheffield UK
Liesbet Geris
GIGA In Silico Medicine University of Liège Liège Belgium
Stefan Dudli
Center of Experimental Rheumatology Department of Rheumatology, University Hospital Zurich, University of Zurich Zurich Switzerland
Jaro Karppinen
Research Unit of Health Sciences and Technology University of Oulu Oulu Finland
Jérôme Noailly
BCN MedTech, Department of Information and Communication Technologies Universitat Pompeu Fabra Barcelona Spain
Christine Le Maitre
Division of Clinical Medicine, School of Medicine and Population Health University of Sheffield Sheffield UK
Benjamin Gantenbein
Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty University of Bern Bern Switzerland
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.
