Conlee Erin M, Driscoll Sherilyn W, Coleman Wood Krista A, McIntosh Amy L, Dekutoski Mark L, Brandenburg Joline E
Department of Physical Medicine and Rehabilitation, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
Department of Physical Medicine and Rehabilitation and Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
PM R. 2019 Jun;11(6):619-630. doi: 10.1016/j.pmrj.2018.10.002. Epub 2019 Mar 7.
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.
腰椎椎体后终板骨折发生于椎体后部的环状骨骺撕脱。虽然这在青少年和年轻成年人中已有描述，但正确诊断常常延迟或完全漏诊。手术可能治愈。
确定青少年和年轻成年人腰椎椎体后终板骨折的常见临床特征及治疗结果。
回顾性病例系列研究。
学术性医疗机构。
2000年至2012年间年龄在10至25岁且诊断为腰椎椎体后终板骨折的患者。
人口统计学特征、诊断性检查、干预措施以及术后症状变化。
共有16例患者发生腰椎椎体后终板骨折（8例男性患者；平均年龄15.2岁），占192例因与创伤、脊柱侧弯或恶性肿瘤无关的原因接受脊柱手术的纳入年龄范围患者的8.3%。最常见的体征和症状为腰背痛及放射至腿部的疼痛、直腿抬高试验阳性、腘绳肌挛缩和步态异常。12例患者（75%）病因与运动相关。平均（范围）诊断时间为13.0（3.0 - 63.0）个月。最常通过腰椎磁共振成像确诊（n = 6）。大多数骨折发生在L5（n = 8，50%）和L4（n = 5，31.3%）。术前尝试了保守治疗措施。9例患者术后“完全缓解”，7例“改善”。
对于有腰背痛、放射至腿部的疼痛及膝关节伸展受限的青少年或年轻成年人，无论症状出现时间长短，在鉴别诊断时均应考虑腰椎椎体后终板骨折。对于保守治疗失败的患者，建议咨询有经验的、专门从事脊柱医学的医生。
IV级。
