MRI of Acute Compression Fracture, Pre-Operative Bone Scan, Consultation and Physical Exam

Vol. 3, Issue 2, Article 1

Westesson, et al.

MRI of Acute Compression Fracture

We use MRI for preoperative evaluation of vertebroplasty in all patients unless contraindicated.

We use precontrast sagittal T1, fat suppressed T2-weighted and postcontrast sagittal fat suppressed T1-weighted images. Imaging matrix is 512 x 256, with a 32 x 24 cm field of view, and 3 mm slice thickness with intersection gap of 0.2 mm.

Plain film shows two compression fractures (T8 and T9). Post-Gadolinium T1-weighted image is especially helpful showing a significantly enhanced T8 indicating a recent fracture. T9 is a chronic fracture and does not need vertebroplasty.

Pre-Operative Bone Scan

In patients who cannot have an MR, we rely on bone scans. A nuclear bone scan can be helpful in identifying which fractures are more acute in nature and most likely to contribute to the patient's symptoms.

Consultation

All patients are seen by a neuroradiologist before the procedure since patient selection is the key to the success of vertebroplasty.
Thorough history including the duration and nature of pain is obtained. The pain should be focal, intense, and deep, and must correspond with imaging findings. There should be no radiation to the legs. The procedure is discussed with the patient and/or his/her family, and benefits, risks, and possible complications are explained. Once the patient's questions are answered we obtain informed consent.
The alleviation of pain does not occur in all patients, reportedly 80% in patients with osteoporotic fractures and even lower in fractures associated with malignant neoplasm. Pain alleviation also depends on acuity of fracture. Potential complications are outlined in Table1.

Physical Examination

Physical examination is important to determine the degree of symptoms and the relationship to the suspected vertebral body.

Table 1: Potential Complications

Possible complications

Bleeding

Infection

Fracture of the pedicle

Damage to the nerve roots or spinal cord

Worsening of symptoms

Spinal cord or nerve root compression (radiculopathy) from cement leakage

Pulmonary embolism

Rib fractures from moving onto the table

Table 1: Potential Complications
Possible complications Bleeding Infection Fracture of the pedicle Damage to the nerve roots or spinal cord Worsening of symptoms Spinal cord or nerve root compression (radiculopathy) from cement leakage Pulmonary embolism Rib fractures from moving onto the table

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