You can deal effectively with fractures of the vertebral endplates by keeping fluid pumping through this fine cartilage interface between the discs and the vertebrae.
The vertebral endplates are the thin cartilaginous interfaces between the discs and the vertebrae above and below. The VEPs are dotted with fine pores that blood vessels in the rich capillary bed in the vertebral bodies butt up to, in order to harvest nutrients to be carried into the heart of the disc. The pores are more densely concentrated in the centre of the disc, over the nucleus, making the endplate weaker here. This means that fractures of the vertebral endplate are most common over the central zone of the vertebral body.
Schmorls nodes are evidence of past fractures of the vertebral endplates ~ and extremely common in everybody's X-rays
The vertebral endplates are the weakest component part of the spine. They can easily suffer minute fracture with traumatic forces transmitted up through the spine. This can be done in any number of ways by traumatic forces within physiological range, such as sitting down hard on the bottom, or even pulling at something, such as a pulling a rope in a tug'o war, or a stubborn root in the garden. Young men in the Forces have more than their fair share of fractures of the vertebral endplates: pilot ejection seats and military exercises that involve jumping off ladder ropes with heavy backpacks can cause this sort of trouble.
An innocuous spinal compression mishap may sometimes start the steady decline of the disc, ending in prolapse of segmental instability
At the time of the incident, patients often say they heard a small popping sound, ping or crack from their back. Although it doesn't cause undue alarm at the time, people often relate their back was 'never quite the same afterwards'. In the aftermath of VEP fracture the vertebra develops typical scoop-shaped indentations in the surface of the vertebral body called Schmorl's nodes. These are commonly seen on the scans, giving some indication to how often we pop a vent in the VEP with never knowing it.
Because they block nutrient pathways, endplate fractures fast-track the breakdown of the intervertebral disc as the small pores in the endplate cartilage heal over. At the same time, the bone immediately behind the endplate becomes tougher and harder (sclerotic) which also impedes the nutrient traffic. The impairment in nutrient exchange can tip the borderline metabolic balance of the disc and speed disc breakdown.
Nutrient pathways through a previously fractured vertebral endplate will be encouraged to return by keeping the spine moving as normally as possible. Normal movement acts like a pump that sucks fluid through the endplate from the blood reservoirs in the neighbouring vertebral bodies. Conversely, keeping the back as still as possible and trying to lessen movement allows the endplates to remain impervious and this starves the discs.
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