Value of MRI imaging prior to a kyphoplasty for osteoporotic insufficiency fractures

Abstract

Previous studies have shown the safety and effectiveness of balloon kyphoplasty in the treatment of osteoporotic vertebral compression fractures (OVCFs). MRI and particularly the short tau inversion recovery (STIR) sequence are very sensitive for detecting vertebral edema as a result of fresh fractures or micro-fractures. Therefore, it has a great therapeutic relevance in differentiating vertebral deformities seen by conventional X-ray and CT scans. Although an MRI scan is expensive, to my knowledge no study has evaluated the benefits of preoperative MRI in evaluating a therapeutic plan for kyphoplasty. This is a prospective study evaluating the benefit of a preoperative MRI scan regarding changes of kyphoplasty therapy. Twenty-eight patients were included in this study. Twenty-four patients were treated by balloon kyphoplasty, in a total of 40 vertebral bodies. The mean age was 73 years. All patients suffered from OVCFs. As a first step, all patients got a CT scan. The individual therapeutic plan was then defined by the patients' history, complaints and the results of the CT scan. As far as all criteria for kyphoplasty were fulfilled, an MRI examination including the STIR sequences was performed preoperatively. The number of times a change was made in therapy as a result from the additional information from the MRI was then evaluated. By performing a preoperatively MRI examination, the therapy plan was changed in 16 out of 28 (57%) patients. Eight patients underwent additional levels of kyphoplasty at the same procedure. In five patients, lesions were found to be old fractures and therefore were not treated operatively. Two of these patients received no kyphoplasty at all. Another patient only a part of the originally intended levels was treated. The other two cases received a kyphoplasty at different vertebral levels, as these vertebral bodies showed signs of an acute fracture in the MRI scan. Additionally, an incidental diagnosis of carcinoma of the kidney was made in two patients. Kyphoplasty was deferred and they were referred for further evaluation. One patient was found to have an aortic aneurysm. Kyphoplasty was performed and after that the patient was referred in order to treat the aneurysm. This study confirms the diagnostic benefits of an MRI scan before performing a kyphoplasty. For 16 out of 28 patients, the therapeutic plan was changed because of the information obtained by preoperative MRI. Preoperative MRI helped to generate the correct surgical strategy, by demonstrating the correct location of injury and by detecting concomitant diseases.

Reliability of the STIR Sequence for Acute Type II Odontoid Fractures

“…The STIR sequence is very sensitive for the detection of osseous and soft-tissue edema as a result of fractures or microfractures 28 and is routinely used to identify such edema in the cervical spine and other skeletal sites. 15 One study showed STIR to be superior to CT in detecting subtle fractures, such as insufficiency fractures.…”

Prediction of immediate and long-term benefit after kyphoplasty of painful osteoporotic vertebral fractures by preoperative MRI

“…Therefore, the presence of a BME may be an essential predictor for a successful pain relief and correction of deformity after treatment of painful vertebral fractures by kyphoplasty. As a consequence, several authors included only patients with vertebral BME revealed by MRI in their trials [1,4,[10][11][12][13][14] and observed pain relief after kyphoplasty. To our knowledge, a comparative evaluation of the short and long-term outcomes of kyphoplasty in painful osteoporotic vertebral fractures with and without MRI edema has not been reported previously.…”

The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2009

“…The paper by Spiegl et al [23] published in the September issue reports the conclusions of a study aiming at identifying the best imaging prior to kyphoplasty. As MRI, especially the STIR sequence, is very sensitive in detecting vertebral edema resulting from fresh fractures, the authors hypothesized that MRI should be superior to X-ray and CT scan in accurately pinpointing the vertebral bodies to be treated and in distinguishing fresh fractures or microfractures from old fractures.…”