Value of Immediate Preprocedure Magnetic Resonance Imaging in Patients Scheduled to Undergo Vertebroplasty or Kyphoplasty

Abstract

In select candidates for vertebroplasty or kyphoplasty, a repeat preprocedure MRI obtained within 1 week can help ensure that all painful fractures are treated. There is demonstrable value in this protocol for patients with an imaging evaluation over 3 months old or who have had any change in symptoms since the initial imaging workup.

Comparative review of vertebroplasty and kyphoplasty

“…It is highly recommended to perform a spine MRI close before any of these percutaneous procedures [63] . The presence of a pattern of bone marrow edema is associated with a good clinical short term success relieving pain [54] .…”

The Value of Dynamic Radiographs in Diagnosing Painful Vertebrae in Osteoporotic Compression Fractures

“…In the time that elapses between the initial MR imaging evaluation and vertebroplasty, it is possible for additional fractures to occur. Benz et al 10 recommended a repeat preprocedural MR imaging obtained within 1 week in select candidates to help ensure that all painful fractures are treated. However, the disadvantages of preprocedural MR imaging include the time, expense, and demands on the radiology department.…”

Point of View

“…Benz and colleagues 6 were able to identify 20 subjects who had repeat MRI prior to vertebral augmentation: 11 had new symptoms, 6 were beyond 3 months prior imaging, and 3 had not had STIR imaging on the initial MRI. One could regard these last 3 patients as not having had adequate imaging in the first place, and so the repeat MRI is actually an initial MRI.…”

“…But why do most patients experience pain relief and others do not? Benz et al 6 argue that a potential explanation for lack of success is that radiographically occult fractures remain untreated. They advocate the use of MRI immediately prior to vertebroplasty to assure that all fractures are identified and treated.…”