VERTEBRAL SUBCHONDRAL BONE AND INTERVERTEBRAL DISC DEGENERATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANGPeng ¹ , ZHOUZhuang ² , ZHANGHeng ¹ , TIANFaming ³ , WANGWenya ⁴ ,  ZHANGLiu ¹

1. Department of Orthopedic Surgery, Affiliated Hospital of Hebei United University, Tangshan Hebei, 063000, P. R. China;
2. College of Postgraduates, Hebei Medical Univeristy, Tangshan Hebei, 063000, P. R. China;
3. Medical Research Center, Hebei United University, Tangshan Hebei, 063000, P. R. China;
4. School of Basic Medicine, Hebei United University, Tangshan Hebei, 063000, P. R. China;

Corresponding author：

ZHANGLiu, Email: zhliu130@sohu.com

Keywords：

Vertebral subchondral bone; Modic change; Subchondral bone sclerosis; Intervertebral disc degeneration

DOI：

10.7507/1002-1892.20150079

Video：

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Objective To review the role of vertebral subchondral bone in maintaining normal physiological function of the intervertebral disc and in the intervertebral disc degeneration in light of bone anatomy, microstructure, histopathological features, and MRI imaging features. Methods The related home and abroad literature concerning vertebral subchondral bone and intervertebral disc degeneration was extensively reviewed and comprehensively analyzed. Results Vertebral subchondral bone is part of the vertebral endplate and is defined as the vascularized cortical and trabecular bone layer located between the cartilage endplate and vertebral body. It not only plays a cushion shocks role in terms of conducting stress and effectively resists the hydrostatic nucleus, but also ensures the normal supply of disc nutrition. Subchondral bone sclerosis caused by bone remodeling abnormality severely decreases the ability of subchondral bone stress absorption and protective function of disc, which finally leads to increased inflammatory factors locally and hindered nutrition pathway of disc and enhanced disc degeneration. Conclusion To further strengthen the knowledge and understanding of the vertebral subchondral bone will play a positive role in the study on the pathogenesis of intervertebral disc degeneration.

Citation： WANGPeng, ZHOUZhuang, ZHANGHeng, TIANFaming, WANGWenya, ZHANGLiu. VERTEBRAL SUBCHONDRAL BONE AND INTERVERTEBRAL DISC DEGENERATION. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(3): 377-380. doi: 10.7507/1002-1892.20150079 Copy

1.	Wang Y, Battié MC, Boyd SK, et al. The osseous endplates in lumbar vertebrae:thickness, bone mineral density and their associations with age and disk degeneration. Bone, 2011, 48(4):804-809.
2.	Rodriguez AG, Rodriguez-Soto AE, Burghardt AJ, et al. Morphology of the human vertebral endplate. J Orthop Res, 2012, 30(2):280-287.
3.	Rahme R, Moussa R. The modic vertebral endplate and marrow changes:pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol, 2008, 29(5):838-842.
4.	Zhang Y, Lenart BA, Lee JK, et al. Histological features of endplates of the mammalian spine:from mice to men. Spine (Phila Pa 1976), 2014, 39(5):E312-317.
5.	Oki S, Matsuda Y, Shibata T, et al. Morphologic differences of the vascular buds in the vertebral endplate:scanning electron microscopic study. Spine (Phila Pa 1976), 1996, 21(2):174-177.
6.	Laffosse JM, Kinkpe C, Gomez-Brouchet A, et al. Micro-computed tomography study of the subchondral bone of the vertebral endplates in a porcine model:correlations with histomorphometric parameters. Surg Radiol Anat, 2010, 32(4):335-341.
7.	Moore RJ. The vertebral end-plate:what do we know? Eur Spine J, 2000, 9(2):92-96.
8.	Grant JP, Oxland TR, Dvorak MF. Mapping the structural properties of the lumbosacral vertebral endplates. Spine (Phila Pa 1976), 2001, 26(8):889-896.
9.	Keller TS, Hansson TH, Abram AC, et al. Regional variations in the compressive properties of lumbar vertebral trabeculae. Effects of disc degeneration. Spine (Phila Pa 1976), 1989, 14(9):1012-1019.
10.	MacLean JJ, Owen JP, Iatridis JC. Role of endplates in contributing to compression behaviors of motion segments and intervertebral discs. J Biomech, 2007, 40(1):55-63.
11.	Eswaran SK, Gupta A, Adams MF, et al. Cortical and trabecular load sharing in the human vertebral body. J Bone Miner Res, 2006, 21(2):307-314.
12.	Jackman TM, Hussein AI, Adams AM, et al. Endplate deflection is a defining feature of vertebral fracture and is associated with properties of the underlying trabecular bone. J Orthop Res, 2014, 32(7):880-886.
13.	Hussein AI, Morgan EF. The effect of intravertebral heterogeneity in microstructure on vertebral strength and failure patterns. Osteoporos Int, 2013, 24(3):979-989.
14.	Margulies JY, Payzer A, Nyska M, et al. The relationship between degenerative changes and osteoporosis in the lumbar spine. Clin Orthop Relat Res, 1996, (324):145-152.
15.	Urban JP, Smith S, Fairbank JC. Nutrition of the intervertebral disc. Spine (Phila Pa 1976), 2004, 29(23):2700-2709.
16.	Palepu V, Kodigudla M, Goel VK. Biomechanics of disc degeneration. Adv Orthop, 2012, 2012:726210.
17.	Rutges JP, Jagt van der OP, Oner FC, et al. Micro-CT quantification of subchondral endplate changes in intervertebral disc degeneration. Osteoarthritis Cartilage, 2011, 19(1):89-95.
18.	Thompson RE, Pearcy MJ, Downing KJ, et al. Disc lesions and the mechanics of the intervertebral joint complex. Spine (Phila Pa 1976), 2000, 25(23):3026-3035.
19.	Ziran BH, Pineda S, Pokharna H, et al. Biomechanical, radiologic, and histopathologic correlations in the pathogenesis of experimental intervertebral disc disease. Spine (Phila Pa 1976), 1994, 19(19):2159-2163.
20.	Stairmand JW, Holm S, Urban JP. Factors influencing oxygen concentration gradients in the intervertebral disc. A theoretical analysis. Spine, 1991, 16(4):444-449.
21.	Kurowski P, Kubo A. The relationship of degeneration of the intervertebral disc to mechanical loading conditions on lumbar vertebrae. Spine (Phila Pa 1976), 1986, 11(7):726-731.
22.	Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology, 1988, 168(1):177-186.
23.	Burke JG, Watson RW, Mccormack D, et al. Spontaneous production of monocyte chemoattractant protein-1 and interleukin-8 by the human lumbar intervertebral disc. Spine (Phila Pa 1976), 2002, 27(13):1402-1407.
24.	Ohtori S, Inoue G, Ito T, et al. Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic Type 1 or Type 2 changes on MRI. Spine (Phila Pa 1976), 2006, 31(9):1026-1031.
25.	Karppinen J, Daavittila I, Solovieva S, et al. Genetic factors are associated with modic changes in endplates of lumbar vertebral bodies. Spine, 2008, 33(11):1236-1241.
26.	张晓冬, 王国柱, 庄汝杰. 腰椎Modic改变的MRI定量与下腰痛相关性研究. 中国骨伤, 2014, 27(3):213-216.
27.	Kjaer P, Leboeuf-Yde C, Korsholm L, et al. Magnetic resonance imaging and low back pain in adults:a diagnostic imaging study of 40-year-old men and women. Spine (Phila Pa 1976), 2005, 30(10):1173-1180.
28.	Burke JG, Watson RW, Mccormack D, et al. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg (Br), 2002, 84(2):196-201.
29.	Nguyen C, Bendeddouche I, Sanchez K, et al. Assessment of ankylosing spondylitis criteria in patients with chronic low back pain and vertebral endplate Modic I signal changes. J Rheumatol, 2010, 37(11):2334-2339.
30.	Rannou F, Ouanes W, Boutron I, et al. High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate Modic signal changes. Arthritis Rheum, 2007, 57(7):1311-1315.
31.	Ayotte DC, Ito K, Perren SM, et al. Direction-dependent construction flow in a poroelastic solid:the intervertebral disc valve. J Biomech Eng, 2000, 122(6):587-593.
32.	Rodriguez AG, Slichter CK, Acosta FL, et al. Human disc nucleus properties and vertebral endplate permeability. Spine (Phila Pa 1976), 2011, 36(7):512-520.
33.	Homminga J, Weinans H, Gowin W, et al. Osteoporosis changes the amount of vertebral trabecular bone at risk of fracture but not the vertebral load distribution. Spine (Phila Pa 1976), 2001, 26(14):1555-1561.
34.	Harada A, Okuizumi H, Miyagi N, et al. Correlation between bone mineral density and intervertebral disc degeneration. Spine (Phila Pa 1976), 1998, 23(8):857-862.
35.	Soukane DM, Shirazi-Adl A, Urban JP. Computation of coupled diffusion of oxygen, glucose and lactic acid in an intervertebral disc. J Biomech, 2007, 40(12):2645-2654.
36.	Williams FM, Manek NJ, Sambrook PN, et al. Schmorl's nodes:common, highly heritable, and related to lumbar disc disease. Arthritis Rheum, 2007, 57(5):855-860.
37.	Zhao JG, Zhang P, Zhang SF, et al. Modic type Ⅲ lesions and Schmorl's nodes are the same pathological changes? Med Hypotheses, 2010, 74(3):524-526.

1. Wang Y, Battié MC, Boyd SK, et al. The osseous endplates in lumbar vertebrae:thickness, bone mineral density and their associations with age and disk degeneration. Bone, 2011, 48(4):804-809.
2. Rodriguez AG, Rodriguez-Soto AE, Burghardt AJ, et al. Morphology of the human vertebral endplate. J Orthop Res, 2012, 30(2):280-287.
3. Rahme R, Moussa R. The modic vertebral endplate and marrow changes:pathologic significance and relation to low back pain and segmental instability of the lumbar spine. AJNR Am J Neuroradiol, 2008, 29(5):838-842.
4. Zhang Y, Lenart BA, Lee JK, et al. Histological features of endplates of the mammalian spine:from mice to men. Spine (Phila Pa 1976), 2014, 39(5):E312-317.
5. Oki S, Matsuda Y, Shibata T, et al. Morphologic differences of the vascular buds in the vertebral endplate:scanning electron microscopic study. Spine (Phila Pa 1976), 1996, 21(2):174-177.
6. Laffosse JM, Kinkpe C, Gomez-Brouchet A, et al. Micro-computed tomography study of the subchondral bone of the vertebral endplates in a porcine model:correlations with histomorphometric parameters. Surg Radiol Anat, 2010, 32(4):335-341.
7. Moore RJ. The vertebral end-plate:what do we know? Eur Spine J, 2000, 9(2):92-96.
8. Grant JP, Oxland TR, Dvorak MF. Mapping the structural properties of the lumbosacral vertebral endplates. Spine (Phila Pa 1976), 2001, 26(8):889-896.
9. Keller TS, Hansson TH, Abram AC, et al. Regional variations in the compressive properties of lumbar vertebral trabeculae. Effects of disc degeneration. Spine (Phila Pa 1976), 1989, 14(9):1012-1019.
10. MacLean JJ, Owen JP, Iatridis JC. Role of endplates in contributing to compression behaviors of motion segments and intervertebral discs. J Biomech, 2007, 40(1):55-63.
11. Eswaran SK, Gupta A, Adams MF, et al. Cortical and trabecular load sharing in the human vertebral body. J Bone Miner Res, 2006, 21(2):307-314.
12. Jackman TM, Hussein AI, Adams AM, et al. Endplate deflection is a defining feature of vertebral fracture and is associated with properties of the underlying trabecular bone. J Orthop Res, 2014, 32(7):880-886.
13. Hussein AI, Morgan EF. The effect of intravertebral heterogeneity in microstructure on vertebral strength and failure patterns. Osteoporos Int, 2013, 24(3):979-989.
14. Margulies JY, Payzer A, Nyska M, et al. The relationship between degenerative changes and osteoporosis in the lumbar spine. Clin Orthop Relat Res, 1996, (324):145-152.
15. Urban JP, Smith S, Fairbank JC. Nutrition of the intervertebral disc. Spine (Phila Pa 1976), 2004, 29(23):2700-2709.
16. Palepu V, Kodigudla M, Goel VK. Biomechanics of disc degeneration. Adv Orthop, 2012, 2012:726210.
17. Rutges JP, Jagt van der OP, Oner FC, et al. Micro-CT quantification of subchondral endplate changes in intervertebral disc degeneration. Osteoarthritis Cartilage, 2011, 19(1):89-95.
18. Thompson RE, Pearcy MJ, Downing KJ, et al. Disc lesions and the mechanics of the intervertebral joint complex. Spine (Phila Pa 1976), 2000, 25(23):3026-3035.
19. Ziran BH, Pineda S, Pokharna H, et al. Biomechanical, radiologic, and histopathologic correlations in the pathogenesis of experimental intervertebral disc disease. Spine (Phila Pa 1976), 1994, 19(19):2159-2163.
20. Stairmand JW, Holm S, Urban JP. Factors influencing oxygen concentration gradients in the intervertebral disc. A theoretical analysis. Spine, 1991, 16(4):444-449.
21. Kurowski P, Kubo A. The relationship of degeneration of the intervertebral disc to mechanical loading conditions on lumbar vertebrae. Spine (Phila Pa 1976), 1986, 11(7):726-731.
22. Modic MT, Masaryk TJ, Ross JS, et al. Imaging of degenerative disk disease. Radiology, 1988, 168(1):177-186.
23. Burke JG, Watson RW, Mccormack D, et al. Spontaneous production of monocyte chemoattractant protein-1 and interleukin-8 by the human lumbar intervertebral disc. Spine (Phila Pa 1976), 2002, 27(13):1402-1407.
24. Ohtori S, Inoue G, Ito T, et al. Tumor necrosis factor-immunoreactive cells and PGP 9.5-immunoreactive nerve fibers in vertebral endplates of patients with discogenic low back Pain and Modic Type 1 or Type 2 changes on MRI. Spine (Phila Pa 1976), 2006, 31(9):1026-1031.
25. Karppinen J, Daavittila I, Solovieva S, et al. Genetic factors are associated with modic changes in endplates of lumbar vertebral bodies. Spine, 2008, 33(11):1236-1241.
26. 张晓冬, 王国柱, 庄汝杰. 腰椎Modic改变的MRI定量与下腰痛相关性研究. 中国骨伤, 2014, 27(3):213-216.
27. Kjaer P, Leboeuf-Yde C, Korsholm L, et al. Magnetic resonance imaging and low back pain in adults:a diagnostic imaging study of 40-year-old men and women. Spine (Phila Pa 1976), 2005, 30(10):1173-1180.
28. Burke JG, Watson RW, Mccormack D, et al. Intervertebral discs which cause low back pain secrete high levels of proinflammatory mediators. J Bone Joint Surg (Br), 2002, 84(2):196-201.
29. Nguyen C, Bendeddouche I, Sanchez K, et al. Assessment of ankylosing spondylitis criteria in patients with chronic low back pain and vertebral endplate Modic I signal changes. J Rheumatol, 2010, 37(11):2334-2339.
30. Rannou F, Ouanes W, Boutron I, et al. High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate Modic signal changes. Arthritis Rheum, 2007, 57(7):1311-1315.
31. Ayotte DC, Ito K, Perren SM, et al. Direction-dependent construction flow in a poroelastic solid:the intervertebral disc valve. J Biomech Eng, 2000, 122(6):587-593.
32. Rodriguez AG, Slichter CK, Acosta FL, et al. Human disc nucleus properties and vertebral endplate permeability. Spine (Phila Pa 1976), 2011, 36(7):512-520.
33. Homminga J, Weinans H, Gowin W, et al. Osteoporosis changes the amount of vertebral trabecular bone at risk of fracture but not the vertebral load distribution. Spine (Phila Pa 1976), 2001, 26(14):1555-1561.
34. Harada A, Okuizumi H, Miyagi N, et al. Correlation between bone mineral density and intervertebral disc degeneration. Spine (Phila Pa 1976), 1998, 23(8):857-862.
35. Soukane DM, Shirazi-Adl A, Urban JP. Computation of coupled diffusion of oxygen, glucose and lactic acid in an intervertebral disc. J Biomech, 2007, 40(12):2645-2654.
36. Williams FM, Manek NJ, Sambrook PN, et al. Schmorl's nodes:common, highly heritable, and related to lumbar disc disease. Arthritis Rheum, 2007, 57(5):855-860.
37. Zhao JG, Zhang P, Zhang SF, et al. Modic type Ⅲ lesions and Schmorl's nodes are the same pathological changes? Med Hypotheses, 2010, 74(3):524-526.

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VERTEBRAL SUBCHONDRAL BONE AND INTERVERTEBRAL DISC DEGENERATION

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