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

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. Level of Evidence IV