What is the treatment for vertebrae end plate deformity?

Treatment of Vertebral End Plate Deformity

Percutaneous vertebral augmentation (VA) is the recommended treatment for vertebral end plate deformity when associated with vertebral compression fractures (VCFs) that cause persistent pain, spinal deformity, or pulmonary dysfunction after initial conservative management. 1

Initial Assessment and Management

• Initial evaluation should include imaging of the spine (X-rays, MRI or CT) to confirm the diagnosis, assess the acuity of the fracture, and plan treatment 1
• Conservative medical management is appropriate as first-line treatment for the initial 3 months in most cases 1
• Medical management includes:
  • Pain control
  • Limited immobilization
  • Osteoporosis treatment if applicable 1

When to Consider Interventional Treatment

Vertebral augmentation should be considered when:

• Medical management fails with persistent or worsening pain after 3 months 1
• Spinal deformity is present (defined as ≥15% kyphosis, ≥10% scoliosis, ≥10% dorsal wall height reduction, or vertebral body height loss ≥20%) 1
• Pulmonary dysfunction is present 1

Vertebral Augmentation Techniques

Two main techniques are available:

• Vertebroplasty (VP): Injection of polymethylmethacrylate (PMMA) cement into the vertebral body 1
• Kyphoplasty (BK): Creation of a cavity using balloon inflation before cement injection 1

Both techniques have shown comparable effectiveness in:

• Pain reduction
• Functional improvement
• Height restoration 1

Special Considerations for End Plate Deformity

• Vertebral end plate injury is commonly seen in osteoporotic vertebral compression fractures and is frequently associated with injury to adjacent intervertebral disks 2
• Superior vertebral end plate injury (39%) is more common than inferior end plate injury (12%) 2
• End plate damage can lead to progressive collapse of the anterior cortex, resulting in wedge deformity 3
• Percutaneous vertebroplasty can reduce pain and deformity associated with vertebral body fractures 1

Potential Complications and Precautions

• Cement leakage occurs in 27-72% of cases but is usually asymptomatic 1
• Major complications occur in <1% of patients treated for osteoporotic compression fractures 1
• Potential complications include:
  • Cement leakage into spinal canal, neural foramina, or venous system
  • Nerve or spinal cord injury
  • Pulmonary embolism
  • Infection
  • Bleeding
  • New fractures 1

Follow-up Management

• Adequate calcium and vitamin D levels should be maintained 1
• Patients should be monitored for new fractures, particularly at adjacent levels 4
• After vertebroplasty, there is an increased risk of inferior end plate fractures in the vertebra immediately above the treated level 4

Alternative Treatments

• For patients with contraindications to vertebral augmentation, continued medical management is appropriate 1
• Surgical intervention is reserved for patients with:
  • Neurologic deficits
  • Significant spinal deformity
  • Spinal instability 1