Research demonstrates that chronic low back pain can be caused by damage to the junction between the vertebral body and the intervertebral discs, called the vertebral endplate.
When vertebral endplate damage is the underlying cause of pain, it is called vertebrogenic pain.
The term “vertebrogenic” simply means:
- “Vertebro” refers to the bones that make up the spinal column, called vertebrae
- “Genic” is a term used in medicine to mean that it originates from or is produced by
So, combining these root terms, vertebrogenic literally means originating from or produced by the vertebra. Other terms that may be used include vertebral pain, endplate pain, basivertebral nerve pain.
The new research identifying pain caused by vertebrae is important because it challenges what was believed about chronic back pain and shifts the focus from “nonspecific” back pain to an identifiable source of pain – specifically, damage to the part of the vertebra that is called the endplate.
Understanding the Essentials of Vertebrogenic Pain
The spinal column is made up of cylindrical bones stacked on top of each other, with cushiony discs in between the vertebrae.
At each level of the spine, there is a vertebral endplate that lies between the vertebra and the disc.
The vertebral endplate is a thin, round structure made of 2 layers:
- A layer of bone that attaches to the vertebral body
- A layer of cartilage that attaches to the spinal disc
The dual layers of the endplate act as a transitional structure between the rigid bone of the vertebra and the flexible spinal discs wedged between the vertebrae.
When endplates are damaged - whether from normal aging, an accident, or inflammation - they release substances that increase nerve sensitivity and cause pain. This creates a cycle where the pain keeps getting worse.
In This Article:
- Vertebrogenic Pain: Everything You Need to Know
- Symptoms of Vertebrogenic Pain
- Treatment for Vertebrogenic Back Pain
- Vertebrogenic Low Back Pain Animation
Sensitive Nerves within the Vertebral Endplate
When endplate damage occurs, it often leads to irritation and inflammation, directly affecting the basivertebral nerve.
We often think of bone as a single solid structure, but it’s actually made of multiple layers and packed with sensitive nerves (which is one reason why a spinal fracture hurts so much).
Like all bone, the bones in the spine are packed with sensitive nerves:
- The vertebral endplates contain highly pain-sensitive nerves, particularly the basivertebral nerve.
- The basivertebral nerve branches off from the spinal cord, traveling into each vertebra in the lower back and spreading into the endplate.
- When endplate damage occurs, it often causes irritation and inflammation that directly impact these nerves, leading to pain signals that can be felt throughout the lower back.
How Endplate Damage Causes Lower Back Pain
Vertebrogenic pain is part of a general degenerative process in the spine, summarized as follows:
Sensitive to Inflammation
The basivertebral nerve is highly reactive to inflammation. When the endplate is damaged, pro-inflammatory proteins called cytokines are released, creating localized inflammation that makes the basivertebral nerve fibers more sensitive.
This heightened sensitivity can lead to sharp, intense pain, especially during movements that put stress on the lower back.
Pain from Nerve Sensitization
As the basivertebral nerve fibers become more sensitive, they react to even minor pressure or stress. This can cause pain to feel sharper, more acute, or stabbing with any movement that compresses the vertebrae and endplates.
This pain can also present as a deep, nagging ache which can be exacerbated by even sitting or standing in one place for too long.
Nerve Growth and Increased Pain Signals
Inflammation in the endplate also triggers growth of new nerve fibers in the area.
These extra nerve fibers amplify pain signals sent to the brain, resulting in a more persistent, aching, or even throbbing sensation that may continue even when the back is at rest.
Degenerative Cycle Worsening Pain
The combination of nerve sensitivity, inflammation, and degeneration can lead to a cycle of increasing pain. Over time, as the endplate and adjacent disc weaken, additional pressure is placed on the facet joints in the back of the spine.
This degenerative cycle can lead to an aching, diffuse pain in the lower back that worsens with prolonged activity or weight-bearing.
How Vertebral Endplate Damage Affects Nerve Function
- As the endplate weakens from injury or age, cracks may form, especially in the center, where it’s thinnest. These cracks allow inflammatory chemicals to seep into the basivertebral nerve endings, intensifying pain.
- Thinner, weaker endplates are also less effective at absorbing pressure, leading to increased stress on the basivertebral nerve. This often results in chronic, dull, aching pain that may worsen over time.
Hallmarks of Vertebrogenic Pain
The interaction between endplate damage and basivertebral nerve irritation creates a unique type of pain that patients describe as:
- Sharp, Stabbing Pain: Often experienced during movements that compress the spine, such as bending or lifting.
- Aching, Persistent Pain: Due to continuous nerve sensitization and inflammation, this pain may be felt even at rest and classically is worsened by sitting for long periods of time.
- Throbbing or Diffuse Pain: As more nerve fibers develop and inflammation persists, pain can feel widespread or throbbing, affecting larger areas of the lower back.
The bottom line is that the combination of inflammation, sensitization, and new nerve growth can lead to varied pain sensations, from sharp and acute to chronic and aching.
How Vertebrogenic Low Back Pain Progresses
There are differences between acute and chronic vertebrogenic pain.
In the early stages, vertebrogenic pain tends to be mild and intermittent with occasional flare-ups from intense physical activities, such as running or cycling.
Over time, the symptoms tend to become more severe and persistent, leading to pain with simple everyday activities, such as walking, climbing stairs, lifting, sitting, and bending.
Factors that contribute to the damage and progression of vertebrogenic pain include:
- Co-existing back problems, such as degeneration in other components of the spinal motion segment, particularly at L4-L5 and L5-S1, as these are the motion segments that bear the most load and stress
- Lifestyle factors such as obesity, any nicotine intake, and a sedentary lifestyle
- Certain types of sports and occupations that repeatedly stress the lower back
There are several spinal conditions that commonly develop alongside vertebrogenic pain, and these co-occurring conditions tend to compound and make the pain worse.
To obtain an accurate diagnosis and treatment for vertebrogenic pain and/or these co-occurring conditions, I recommend consulting a spine specialist, such as a physiatrist, interventional pain management physician, orthopedic or neurosurgical spine surgeon, or physical therapist.
