Having endplate sclerosis can be such a bummer as we consider the spinal cord as one integral part. But that is not correct. It is composed of several small parts connected and synchronised. It is to perform the most critical function of holding the body together and up.
Did you know an endplate, is a small part of the spine? And, it can play a very vital role in keeping the vertebra and the disc in good shape? But what happens when the endplate itself degrades? Also, why does it degrade? Can we prevent the endplate sclerosis?
Yes, we can! Read along to know how to do that?
What Are Endplates?
According to verywellhealth, a vital component of the human skeleton is the spinal cord. It is a marvellous structure. Moreover, it holds the body erect and bears lots of weight. Also, it provides immense flexibility and movement to the body. It is firm but not rigid. In short, the bending, stretching, twisting motions of the spinal cord are possible because of the unique design of the spinal cord.
The vertebral column consists of 33 vertebras, divided into four zones:
- Cervical: This is in the neck region. It supports the neck and moves it too.
- Thoracic: The upper back has the thoracic part of the spinal cord
- Lumbar: The lower back has a lumbar region. And here also lots of movement happens.
- Sacral: This is the lowermost part of the spin. It goes right up to the tail bone.
The vertebrae are connected flexibly like a chain. And, in between the vertebras are Intervertebral disc (generally called as a disc). The discs are very soft and pulpous. As a result, the vertebras can move without rubbing against each other. Else, it would have otherwise damaged them.
The disc provides the lubricated binding between the vertebras. The vertebras are hard and bony. But, the discs are very soft. If the vertebrae lay directly on the disc, they may severely damage the disc. It is because of their rough surface. Instead, there is an ‘endplate’ between ever vertebra and the disc.
Construction Of Endplate
This endplate is constructed of two layers which are bound together as the spine-health said.
- The bony endplate: This is the porous bony part of the endplate. It is attached to the vertebra. Additionally, these have a thickness of 0.2mm to 0.8mm
- Cartilaginous endplate: The disc side endplate, built of cartilage. These are relatively soft and flexible. However, the width of this section various from 0.1 mm to 2.0 mm. The lumbar region has thicker endplates than the thoracic region.
These two-layers exist as a fused layer to form the endplate. So, every junction of the vertebra and the disc will have an endplate between them.
What Is Endplate Sclerosis?
The function of the endplate is to provide a transitional texture between the hard vertebra and soft disc. However, the porous part of the endplate supplies blood and nutrients to the intervertebral disc. These discs do not have any other means to receive blood or nutrition.
A healthy young adult has dense, thick and well-curved endplates. Also, they perform beautifully. But with age, these endplates flatten out. They tend to become thinner and brittle.
The degradation of the endplate is also possible because of some injury, compression of the spinal cord. A sedentary lifestyle is a major assigning factor to the deterioration of the endplate.
The endplate gets damaged to develop lesions. However, minor lesions do not show any unusual symptoms. But severe lesions lead to sclerosis. These can have a significant impact on the endplate and the disc too.
Lesions or sclerosis in the lumbar region results in pain in the lower back. Individually, this pain varies from being mild to very severe at times.
They may also result in damage to the disc. Furthermore, it could lead to herniated disc or slipped disc or pinched and irritated nerve.
Is Endplate Sclerosis Severe?
In short, one must consider endplate sclerosis seriously. Though, in milder forms, it may not result in any great harm or discomfort.
But in the aggravated situation, it can have a domino effect and it can trigger lots of serious complications. There may be pain or discomfort in the spinal cord. Then, it is always advisable to get it checked. This way, one can rule out the possibility of endplate sclerosis.
If the doctor feels so, one can go for Magnetic Resonance Imaging (MRI). It checks the presence of endplate sclerosis. Also, the MRI gives a conclusive verdict on this disorder. Modic changes in the MRI, named after Dr. Modic, helped the doctor detect the existence of this sickness.
Endplate sclerosis very often affects the lumbar region. Though, theoretically, it can happen anywhere in the spinal cord.
What Causes Endplate Sclerosis?
The endplate is a part of a structure that bears a lot of weight and involves movement. So the prevalent cause of endplate sclerosis are:
- Sedentary lifestyle: If the physical activities are less, the spinal cord tends to go stiff. Furthermore, this may affect the endplate. A body which has reasonably active movement throughout the day, is at a lower risk, comparatively.
- Bad Postures: Unnatural and unhealthy sitting or standing postures inflicts undue strain on the spinal cord. At times, the spinal cord stays in a particular position for a very long time. It tends to dislocate and damage the endplates and also, the discs. The alignment of the spinal cord is disturbed, which is not advisable.
- Overweight: A hefty and obese body overloads the spinal cord. The endplate is constituents of the spinal cord. Any heavyweight has to be shared by it as well. Since the cartilages are soft, but because of the weight, they tend to thin out. Furthermore, in worse cases, they may be damaged as well.
- Spinal compression: All the spinal cord components have their place and position. But, in the case of any vertical spinal cord compression, the parts will lose their place. Also, they get dislodged. So. the endplates too can be compressed or displaced because of this.
- Accident: A direct impact on the spinal cord takes its toll on the endplates, disc and the vertebras too.
How To Treat Endplate Sclerosis?
Do not take the endplate sclerosis lightly. Instead, initiate the remedial action, with the first indication of this disorder.
Possible corrective actions can be:
- Weight loss – Bodyweight substantially defines the stress on the spinal cord and its components. Therefore, make all efforts to reduce body weight. Also, bring it with the standard and acceptable limits as soon as possible. Moreover, seek advice from nutritionist or health expert.
Generally, even a 5%-10% reduction in the weight can relieve the endplate damage greatly.
- Physical Therapy – Exercises, when performed under the supervision of a therapist, will ease the endplate considerably. But, if the disorder is because of overweight or faulty posture, physical therapy will be beneficial.
However, one should be careful to exercise at the instructions of an expert. Else, the situation may aggravate. Physical therapy will not only alleviate the pain but increase the range of motion. Also, reduce structural discomfort.
The body posture will come back to normal. Further, this will help in reducing the symptoms.
- Medications – At times, the ensuing symptom is challenging to bear. However, medicines help to reduce pain and inflammation. Though self-medication not advised. Instead, consult a doctor for the right kind of medication which may suit one’s body constitution and make up.
Generally, Tylenol and non-steroidal anti-inflammatory drugs (NSAIDs), bring relief. The doctor may also suggest tricyclic antidepressants or opioids. Since medications have their side effects, these should be in consultation with a medical practitioner. Typically, mild to moderate symptoms get managed by drugs.
In case of severe symptoms, surgery is an option. The endplates get eroded entirely. Or they have shifted too much from the place. Then, surgery is the solution. Spinal surgery is very critical. An experienced and knowledgeable surgeon should do it.
In such a case, the surgery for the endplates could go two ways:
- Spinal Fusion Surgery: The intermediate disc and the endplates get entirely removed. The adjacent vertebras fused as one.
- To help grow new bone: In this case, using the latest stem cell technology, growth factor and gene therapy, an attempt is made to develop a new structure in the place of the damaged one.
Looking at the severity of the disorder, either of the above can treat. Also, a combination of these can manage the endplate sclerosis.
How To Treat The Endplate Sclerosis And Osteophyte Formation?
Smooth bony projections from some joint or bone are known as an osteophyte. They are also known as bone spurs.
The growth of the bone spurs is the reaction of the bone to the changes that happen around it. The most common situation is the degradation of cartilage around the bone. Because of this, the bone gets exposed to the external agents. Also, with the presence of the bone cartilage, the pressure on the bone reduces. But now without the cartilage, all force is on the bone. The reaction of the bone is to increase the surface area by developing bone spurs. However, force remaining constant, the increase in the surface area reduces the pressure (force/square unit of area).
It is how it tries to defend against the lost cartilage and increase in strength. Such a phenomenon is common around joints. Also, found in the spinal cord.
Endplate sclerosis and osteophyte formation may have a relation. The endplate sclerosis happens when the cartilage of the endplate thins out or erodes. The bone in the close vicinity of cartilage exposes to full force. Now with no support from the cartilage.
Consequently, it induces bone spurs to form. The body forms the spurs as a healing or defence mechanism to counter the loss of cartilage. But unfortunately, this hinders the normal function. The spurs make the joint movement very creaky and irritating. Sometimes it pains and the pain is quite severe when the abrasion is high.
In some cases, the spur may pinch a nerve, typically in the spine. The condition is known as the irritated or pinched nerve. Sciatica is a result of a pinched nerve. So that was to explain the damage a spur could do.
How To Treat Osteophytes?
Since this condition concerns with extraneous growth, medicines treat the symptom.
But before that, physical therapy is also a viable treatment which is possible. Movement of a joint in a controlled manner under the guidance of the therapist relieves the stiffness. Also, it alleviates the pain to a great extent.
Physical therapy also strengthens the associated muscles. As a result, the strong muscles can share the strain of the bone and joints to a great extent. That is how physical therapy can bring in dual advantage.
If one has to take medications, please consult a doctor. Self-medication is not a healthy and safe option. The following are the choices available in medicine:
- NSAIDs: Non-steroidal anti-inflammatory drugs. It brings down the inflammation and associated pain.
- Analgesics: This is fundamentally to manage the pain in the bone and surrounding areas.
- Steroid: Steroids are recommended in the advanced stage of medication. Therefore, one must consult a doctor if it is necessary.
- Surgery: In some cases, the osteophyte pinches a nerve, and the result is drastic and unbearable. So there is no choice except to go for surgery. The surgery intends to free the pinched nerve.
But in quite a few cases, the spurs reappear after surgery. Besides, that is the only viable option in those cases.
Endplate Sclerosis And Vacuum Disc Phenomenon
The phenomenon in which gas (nitrogen in particular) accumulates in the intervertebral disk or the vertebra. Termed as a Vacuum Phenomenon, VP, which was discovered some eighty years back.
We found out at the journals.lww, that the VP is associated with the degeneration of the disc. The behaviour of the gas is very dependent on the movement of the vertebras. When the action is such that they contract, the gas in the spinal space contracts.
In the movement of stretching, the vacuum gets created in the vertebrae. Then it sucks the most insoluble gas, nitrogen, from other parts of the spinal cavity to the section in focus.
Generally, it is an observation that sometimes the atmospheric pressure decreases. Then, because of the VP, pain develops in the spinal cord. Hence at higher altitudes, the VP is painful.
The most common cause of VP in the spine is the disk degeneration. Additionally, endplate sclerosis can be a cause for disk degeneration.
Subsequently, a connection does exist between the endplate sclerosis and vacuum phenomenon.
The spinal cord is a biological marvel and engineering at its best. Small intricate parts build up such a robust spinal cord. On the whole, it holds the weight of the body. Also, it is the information highway of the body. Therefore, the endplate is one of such vital components of the spinal cord and it plays a prominent role in the overall performance of the spinal cord.
However, because of lifestyle, overweight and some other causes, sclerosis may set in. In the initial stages, it is manageable. But severe cases may warrant surgery.