Significance of Endplate Disruption in Defining Surgical Management in Thoracolumbar Burst Fractures

Introduction: Endplate fracture is a tear in the bone and cartilage superior or inferior of a spinal disc. These fractures are often seen in compression fractures, such as a burst fracture, typically requiring surgical intervention. However, the impact of endplate fractures on burst fracture management remains unclear. This study aims to quantify the association between the type of endplate fractures and the likelihood of surgical intervention in patients with burst fractures.

Methods: We retrospectively reviewed 177 patients with burst fractures treated from 2018 to 2023 using a statewide institutional database to evaluate factors associated with surgical intervention or medical management in patients. 96 patients had an endplate fracture. Patients were categorized by the presence of superior, inferior, or both endplate fractures. 90 patients had superior endplate fractures, 6 had inferior endplate fractures, and 81 patients had both endplate fractures present. Demographic and clinical characteristics were compared using Chi-square and Fisher’s exact tests, and multivariable logistic regression analyses were conducted to identify the model with the optimal performance metrics determining surgical versus medical management. The primary outcome was the need for surgical intervention. Logistic regression analysis was performed to assess the association between type of endplate fracture and surgical intervention, adjusting for potential confounders.

Results: The presence of both superior and inferior endplate fractures was significantly associated with increased odds of surgical intervention (OR 4.63, 95% CI: 1.58-13.6, p = 0.005). Inferior endplate fractures alone did not show statistical significance compared to superior endplate fractures (OR 3.18, 95% CI: 0.21-48.4, p = 0.404).

Conclusion : Patients with both superior and inferior endplate fractures increase the likelihood of surgical intervention in burst fractures compared to those only with superior or inferior endplate fractures. This finding provides supporting evidence that not only the presence, but the types of endplate fractures play a critical role in surgical decision making.