Abstract: Endplate defects are a key pathological basis for intervertebral disc degeneration and degenerative low back pain. They cause pain by disrupting the nutritional pathway of the intervertebral disc, altering the local biomechanical environment, and triggering inflammatory responses. Imaging studies show that endplate defects are significantly correlated with intervertebral disc height, Pfirrmann grade, and the incidence of Modic changes, indicating their important role in degenerative low back pain. This article summarizes intervention strategies for endplate defects, focusing on biomechanical interventions, anti-inflammatory drugs, regenerative medicine, and image-guided precision treatments. Additionally, it explores the potential of combining traditional Chinese and Western medicine in treating low back pain associated with endplate defects. Future research should focus on integrating imaging, biomechanics, and molecular biology evidence to further clarify the role of different types of endplate defects in disease progression and explore treatment models based on integrative medicine to promote personalized treatment for degenerative low back pain.