Treatment of Superior Endplate Fracture
Most minor superior endplate fractures do not alter clinical management and are treated conservatively with analgesics, activity modification, and bracing, as these fractures are commonly missed on routine imaging without clinical consequence. 1
Initial Assessment and Classification
Superior endplate fractures are the most common type of vertebral endplate injury, occurring in approximately 57% of osteoporotic vertebral compression fractures, compared to only 11% for inferior endplate fractures. 2 The location and extent of the fracture determines treatment approach:
- Minor, nondisplaced superior endplate fractures detected on CT imaging typically do not require intervention beyond conservative management 1
- Symptomatic vertebral compression fractures with endplate involvement require more aggressive treatment, though only one-third of vertebral fractures are symptomatic and approximately 10% require hospitalization for pain 1
Conservative Management (First-Line Treatment)
The majority of superior endplate fractures are managed non-operatively with the following approach:
- Analgesics for pain control as the primary intervention 1
- Activity modification to reduce mechanical stress on the fractured endplate 1
- Bracing to provide external support and limit motion 1
Rehabilitation Protocol
Early mobilization with structured physical therapy is essential to prevent complications:
- Early postfracture introduction of physical training and muscle strengthening should begin as soon as pain allows 1
- Long-term continuation of balance training to prevent future falls 1
- Multidimensional fall prevention strategies particularly in elderly patients 1
Surgical Considerations
Operative intervention is rarely indicated for isolated superior endplate fractures unless specific criteria are met:
- Severe vertebral body height loss (>1/3 of vertebral height) may warrant consideration of surgical stabilization 3
- Complete endplate fractures involving both superior and inferior endplates have higher rates of postoperative complications and may require more aggressive fixation 4
- Neurological compromise or spinal cord compression requires urgent surgical evaluation 1
Surgical Technique When Required
If surgery is necessary, posterior spinal fixation with penetrating endplate screws provides superior stability compared to conventional pedicle screws, with significantly lower screw loosening rates (3% vs 49%). 5
Secondary Prevention (Critical Component)
All patients aged 50 years and older with superior endplate fractures require systematic evaluation for osteoporosis to prevent subsequent fractures:
- DXA scanning of spine and hip to assess bone mineral density 1
- Calcium and vitamin D supplementation as baseline non-pharmacological treatment 1
- Pharmacological osteoporosis treatment with agents proven to reduce vertebral, non-vertebral, and hip fracture risk 1
- Smoking cessation and alcohol limitation as modifiable risk factors 1
Important Clinical Pitfalls
Superior endplate fractures are frequently under-reported on radiology reports despite being visible on imaging, which can lead to inadequate osteoporosis evaluation and missed opportunities for secondary fracture prevention. 2 Clinicians should specifically review imaging for endplate integrity even if not mentioned in the official report.
Vertebral height loss and kyphotic deformity progression occur commonly after endplate fractures, even with appropriate treatment, particularly when the anterior portion of the superior endplate is involved. 4 Patients should be counseled about this expected outcome.
Adjacent-level intervertebral disk injury occurs in approximately 36% of cases with superior endplate fractures and may contribute to ongoing symptoms. 2