The vertebral endplate is the thin cartilaginous and bony interface between the vertebral body and the intervertebral disc, consisting of a hyaline cartilage layer overlying a thin cortical bone plate with central perforations. The endplate is the critical interface for disc nutrition (by diffusion through the cartilaginous plate from vertebral body vasculature) and for load transfer between the disc and vertebra. Its structural integrity determines disc health and its failure produces Schmorl's nodes (disc herniation through the endplate).
Modic changes (MRI signal changes adjacent to vertebral endplates in disc degeneration) are graded I (acute, T1 dark/T2 bright — vascular reactive change), II (chronic, T1 bright/T2 bright — fatty replacement), and III (sclerotic, T1 and T2 dark — eburnation), reflecting progressive endplate pathology from disc degeneration. Modic type I changes correlate with discogenic back pain and are a target for intradiscal injection therapy. Osteoporotic vertebral compression fractures primarily involve the anterior vertebral endplate, leading to anterior wedge collapse visible on radiograph.
Acute inflammatory Modic I changes at the vertebral endplate (T1 hypointense, T2 hyperintense on MRI) represent vascular fibrovascular tissue in fissured endplate adjacent to a degenerated disc and correlate with axial discogenic back pain; intradiscal corticosteroid or antibiotic treatment targets the inflammatory endplate response in selected patients.
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