Posterior Vertebral Endplate Fractures: A Retrospective Study on a Rare Etiology of Back Pain in Youth and Young Adults.
Adolescent
Athletic Injuries
/ diagnosis
Biomechanical Phenomena
/ physiology
Child
Contracture
/ etiology
Diskectomy
Electromyography
Female
Gait
/ physiology
Hamstring Muscles
/ physiopathology
Humans
Laminectomy
Low Back Pain
/ etiology
Lumbar Vertebrae
/ diagnostic imaging
Magnetic Resonance Imaging
Male
Pelvis
/ physiopathology
Retrospective Studies
Spinal Fractures
/ diagnosis
Tomography, X-Ray Computed
Young Adult
Journal
PM & R : the journal of injury, function, and rehabilitation
ISSN: 1934-1563
Titre abrégé: PM R
Pays: United States
ID NLM: 101491319
Informations de publication
Date de publication:
06 2019
06 2019
Historique:
received:
02
04
2018
accepted:
03
10
2018
pubmed:
23
10
2018
medline:
6
5
2020
entrez:
23
10
2018
Statut:
ppublish
Résumé
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. To determine the common clinical features and treatment outcomes in youth and young adults with posterior lumbar vertebral endplate fractures. Retrospective case series. Academic medical institution. Patients 10 to 25 years old from 2000 through 2012 with posterior vertebral endplate fracture diagnosis. Demographic characteristics, diagnostic studies, interventions, and change in symptoms postoperatively. 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." 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. IV.
Sections du résumé
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.
Identifiants
pubmed: 30347255
pii: S1934-1482(18)30995-X
doi: 10.1016/j.pmrj.2018.10.002
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
619-630Informations de copyright
© 2018 American Academy of Physical Medicine and Rehabilitation.