Vertebral Fractures
Selection of Candidates for Treatment
Patient selection is the critical factor in achieving treatment success.
Incidental compression fractures are common in elderly patients with back pain due to other problems, such as disk disease and spinal stenosis.
The diagnostic radiologist plays a major role in correlating symptoms with imaging findings, and excluding patients who are unlikely to obtain pain relief from augmentation therapy.
Appropriate candidates for the vertebral augmentation can present with a variety of pain syndromes. Often, they have back pain that gets worse over the course of the day and/or with activities. The pain level is likely to correspond to the site of the fracture. There are many variants of this and often patients present with band like distributions of pain ("a tight belt") emanating from the site of the fracture. On physical examination, point tenderness over the appropriate level can be diagnostic.
Conventional x-rays can be used to identify a new compression fracture, but advanced imaging is typically needed to determine whether a fracture is healed or not healed in patients with multiple vertebral compressions.
Healed fractures do not necessarily benefit from augmentation therapy.
Advanced imaging also helps to distinguish osteoporotic fracture from metastasis or infection, and is necessary to ensure that vertebroplasty can be performed safely.
MRI is generally the best single test in assessing for the likelihood of benefit from augmentation.
A diagnosis of vertebral compression fracture includes the doctor taking a good history, a physical examination, plain x-rays and advanced imaging such as MRI and/or CT scans.
Once this evaluation is completed, it can be determined if the patient has one or more compression fractures, if they are healed and thus not painful or unhealed and responsible for the patient's pain.
Sometimes there is no compression fracture and another cause for pain is discovered such a degenerative disc disease, a herniated disc or other causes for back pain including degenerative arthritis of the spine, spinal infection, cancer, etc.
MRI shows a recent or otherwise unhealed vertebral compression fracture (arrow in A & B). Note difference between the fracture and the normal adjacent vertebrae. The fracture characteristics on MRI indicate that this is what is causing the patient's back pain.
Treatment
Copyright © 2008, Joel Garris MD, FACR. All rights reserved.
INTERVENTIONAL RADIOLOGY
Minimally Invasive Alternatives to Surgery
Diagnosis
