Posterior Vertebral Endplate Fractures: A Retrospective Study on a Rare Etiology of Back Pain in Youth and Young Adults

Abstract

Background: Posterior lumbar vertebral endplate fracture occurs with avulsion of the ring apophysis from the posterior vertebral body. Although this has been described in adolescents and young adults, proper diagnosis is often delayed or missed entirely. Surgery may be curative. Objective: To determine the common clinical features and treatment outcomes in youth and young adults with posterior lumbar vertebral endplate fractures. Design: Retrospective case series. Setting: Academic medical institution. Patients: Patients 10 to 25 years old from 2000 through 2012 with posterior vertebral endplate fracture diagnosis. Main Outcome Measurements: Demographic characteristics, diagnostic studies, interventions, and change in symptoms postoperatively.Results: A total of 16 patients had posterior vertebral endplate fractures (8 male patients; mean age, 15.2 years)-8.3% of 192 patients with inclusion age range undergoing spinal surgery for causes unrelated to trauma, scoliosis, or malignancy. The most common signs and symptoms were low back and radiating leg pain, positive straight leg raise, hamstring contracture, and abnormal gait. Cause was sports related for 12 patients (75%). Mean (range) time to diagnosis was 13.0 (3.0-63.0) months. Diagnosis was most commonly made with lumbar magnetic resonance imaging (n = 6). Most fractures occurred at L5 (n = 8, 50%) and L4 (n = 5, 31.3%). Conservative measures were trialed before surgery. Nine patients had "complete relief" following surgery and seven "improved." Conclusions: Posterior vertebral endplate fracture should be considered in differential diagnosis of a youth or young adult with back pain, radiating leg pain, and limited knee extension, regardless of symptom onset. For patients in whom conservative management fails, consultation with an experienced physician whose practice specializes in spine medicine is recommended.

Does Percutaneous Endoscopic Lumbar Discectomy for Adolescent Posterior Ring Apophysis Fracture Accompanied with Lumbar Disc Herniation Have Better Outcome Than Lumbar Disc Herniation Alone?

“…The typical pathological feature of ring apophysis fracture inducing the displacement of the posterior edge of the vertebral body or the fracture entering into the spinal canal makes nerve root decompression insufficient. 5 Therefore, it is more meaningful to compare PELD efficacy in treating APRAF accompanied with LDH and LDH alone. It is reported that PELD achieved satisfactory results in treating PRAF (type III) accompanied by LDH, with an excellent and good rate of 93.4%.…”

“… 2 , 4 , 6 Owing to the very low incidence rate of PRAF, clinicians often lack awareness of this condition, leading to a delayed or missed diagnosis. 5 PRAF can be accurately diagnosed using computed tomography (CT) evaluation. 5 Based on the CT scan fracture positioning, Takata et al classified PRAF into four categories.…”

“…[2][3][4] PRAF is an extremely rare etiology of adolescent low back pain. [2][3][4][5] Repeated microtrauma and physiological delay in posterior vertebral endplate ossification in adolescents and young adults are typically considered the main contributors to PRAF. 2,4,6 Owing to the very low incidence rate of PRAF, clinicians often lack awareness of this condition, leading to a delayed or missed diagnosis.…”

“…5 PRAF can be accurately diagnosed using computed tomography (CT) evaluation. 5 Based on the CT scan fracture positioning, Takata et al classified PRAF into four categories. 4,[7][8][9] Type I represents the separation of the entire posterior margin; type II represents the partial vertebral separation fracture including the margin; type III represents laterally located fractures; type IV represents vertebral body edge fracture that spans the entire vertebral body.…”

Lumbar disc herniation in juveniles: A case–control study of MRI characteristics and etiological insights

“…JDH was defined as LDH on MRI with concordant radicular leg pain or radiculopathy, regardless of the presence or absence of back pain, in patients 20 years old or younger when the clinical diagnosis was first established 14 . The age of 20 years was used because the growth of the skeletal system is nearly completed at the end of the second decade of life 15 . For each participant in this study, the study protocol was briefly explained and written/electronic consent was obtained.…”