Seeing Double

A Comparison of Microstructure, Biomechanical Function, and Adjacent Disc Health Between Double- and Single-Layer Vertebral Endplates

Abstract

Study design. 

Experimental and computational assessment of thickness, porosity, biomechanical behavior, and adjacent disc glycosaminoglycan content in double- and single-layer bony endplate samples harvested from human cadaver spines.

Objective. 

To determine if the second layer of bone in double-layer vertebral endplates allows the superficial layer to achieve a more optimal balance between its biomechanical and nutritional functions.

Summary of Background Data. 

Proper disc health requires the endplate to balance opposing biomechanical and nutritional functions. Previous studies investigating endplate function report seeing double: some endplates have a second layer of bone. However, it remains unclear whether the second layer of bone has any functional advantage. Such information could shed light on the factors that protect against disc degeneration.

Methods. 

Six lumbar spines were obtained from human cadavers (32–84 yr) and scanned with magnetic resonance imaging. Cylindrical cores that included the endplate and underlying trabecular bone were harvested from the center of the superior vertebral endplates (6 double- and 12 single-layer endplates) and imaged using micro–computed tomography. The thickness and porosity of the bony endplate layers were measured for each core. High-resolution finite element analysis was performed to assess biomechanical behavior. Glycosaminoglycan content within the adjacent nucleus tissue was quantified using the dimethylmethylene blue technique.

Results. 

The superficial layer of the double-layer endplates was 50% thinner (P = 0.009) and tended also to be more porous than single-layer endplates. Strains were higher in thinner endplates; however, the second layer of bone in the double-layer endplates had a stiffening effect so that despite being thinner than single-layer endplates, the superficial layer of the double-layer endplates had a similar risk of damage. After adjusting for age, glycosaminoglycan content was significantly higher in the nucleus tissue adjacent to the double-layer endplates (P = 0.01).

Conclusion. 

Compared with single-layer endplates, double-layer endplates seem to permit a more optimal balance between endplate biomechanical and nutritional functions, and may therefore offer a significant protective factor against disc degeneration.

In Brief

Double-layer vertebral endplates are often observed in the spine, but it is unclear whether they have any functional advantage. Addressing this issue, we determined that double-layer endplates appear to permit a more optimal balance between endplate biomechanical and nutritional functions, and may therefore offer a significant protective factor against disc degeneration.