Posterior vertebral rim fractures

Fracture of the posterior vertebral endplate is a cause of low back pain in adolescents and young adults. Clinically it resembles an acute disc prolapse with low back pain and radiculopathy, but may present with neurogenic claudication due to spinal stenosis in older patients. The lesions may be incidental findings. Plain radiographs are diagnostic in about 40% of cases. CT shows the fracture fragment and vertebral defect in most cases but the fracture fragment may be overlooked on MRI. Accurate diagnosis is essential as the surgical technique for disc herniation is inadequate for endplate fractures. In this pictorial essay we review the imaging findings.