What is the distinction between a superior endplate fracture and a compression fracture?

From the Guidelines

A superior endplate fracture and a compression fracture of the vertebra are distinct spinal injuries, with the key difference lying in the extent of damage, where endplate fractures are more localized and compression fractures affect the entire vertebral body. The distinction between these two types of fractures is crucial for determining the appropriate treatment approach and prognosis. A superior endplate fracture specifically affects the upper surface of the vertebral body, while a compression fracture involves the collapse of the entire vertebral body. Endplate fractures often result from axial loading or trauma and may be associated with disc herniation, as noted in studies on vertebral compression fractures 1.

Key Differences

• Endplate fractures are more localized to the interface between the disc and vertebra
• Compression fractures affect the structural integrity of the entire vertebral body
• Endplate fractures may be associated with disc herniation
• Compression fractures typically occur due to osteoporosis, trauma, or malignancy, and present with more significant height loss of the vertebra

Treatment Approaches

• Mild cases of either may require conservative management with pain control (acetaminophen, NSAIDs), brief rest, and gradual physical therapy
• More severe compression fractures might necessitate vertebroplasty or kyphoplasty to stabilize the vertebra, as suggested by the American College of Radiology 1
• Endplate fractures rarely require surgical intervention unless there's significant disc involvement or neurological compromise
• Medical management, including nonsteroidal anti-inflammatory drugs and narcotics, may be used to complement other treatment strategies, but narcotics should be used with caution due to associated risks 1

Importance of Imaging Studies

• Imaging studies, particularly MRI, are crucial for distinguishing between these conditions as treatment approaches and prognosis differ substantially
• MRI can help identify the extent of damage and guide treatment decisions, as noted in studies on the management of vertebral compression fractures 1

From the Research

Distinction between Superior Endplate Fracture and Compression Fracture

• A superior endplate fracture refers to a fracture that occurs at the superior endplate of a vertebra, which is the upper surface of the vertebra that interfaces with the adjacent vertebra 2.
• A compression fracture, on the other hand, is a type of fracture that occurs when a vertebra collapses, often due to osteoporosis or trauma, resulting in a reduction in vertebral height 3.
• The distinction between a superior endplate fracture and a compression fracture lies in the location and nature of the fracture, with superior endplate fractures typically occurring at the upper surface of the vertebra and compression fractures involving the collapse of the entire vertebra.

Characteristics of Superior Endplate Fractures

• Superior endplate fractures are more common than inferior endplate fractures, with a study finding that 57% of prevalent fractures occurred at the superior endplate, compared to 11% at the inferior endplate 2.
• Traumatic endplate fractures, which include superior endplate fractures, tend to involve the anterior endplate more than the posterior endplate 4.
• Superior endplate fractures can be identified using radiological methods, including plain radiographs, computed tomography, and magnetic resonance imaging, with evidence of endplate fracture being a primary indicator of osteoporotic fracture 5.

Characteristics of Compression Fractures

• Compression fractures are the most common complication of osteoporosis, with 700,000 cases reported every year in the United States 3.
• Compression fractures typically present with abrupt-onset low back pain, with or without a history of trauma, and can be diagnosed using plain radiographs, computed tomography, and magnetic resonance imaging 3.
• Compression fractures can be treated with a combination of nonsurgical modalities, including medications, bracing, and physical therapy, as well as surgical procedures such as kyphoplasty or vertebroplasty 3, 6.