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

Benz, Becky K., MD; Gemery, John M., MD; McIntyre, John J., MD; Eskey, Clifford J., MD, PhD

doi: 10.1097/BRS.0b013e31819740bb

Study Design. Retrospective case series.

Objective. To determine the incidence of additional vertebral compression fractures diagnosed with repeat MRI immediately before vertebroplasty or kyphoplasty.

Summary of Background Data. Vertebral compression fractures, which occur frequently in the elderly, are more likely in patients with prior vertebral compression fracture. When patients are evaluated for vertebroplasty, it is important to identify all unhealed fractures for effective treatment planning.

Methods. In a retrospective study, we reviewed the records of all patients (n = 194) treated with vertebroplasty or kyphoplasty over a 6-year period at our institution, and identified all patients who had undergone a repeat MRI within 7 days of vertebroplasty or kyphoplasty. These studies were obtained as part of a clinical protocol prescribing a repeat MRI for any patient whose MRI had been obtained more than 3 months before the evaluation, or who had a change in their pain between referral and evaluation.

Results. Twenty patients met inclusion criteria for the immediate preprocedure MRI protocol. A total of 14 new fractures in 11 patients were discovered on the immediate preprocedure MRI. Of these 14, 6 had less than 15% loss of height, making them potentially occult on radiographs; 3 fractures developed in 2 patients who had no change in back pain.

Conclusion. 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.

We retrospectively reviewed the results of an immediate preprocedure imaging protocol for patients scheduled for vertebroplasty or kyphoplasty. In carefully selected patients, MRI often demonstrated compression fractures that were not present previously. This imaging protocol can provide valuable information that substantially alters patient treatment.

From the Department of Radiology, Dartmouth Hitchcock Medical Center, Lebanon, NH.

Acknowledgment date: June 30, 2008. Revision date: October 9, 2008. Acceptance date: October 9, 2008.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Clifford J. Eskey, MD, PhD, Dartmouth Hitchcock Medical Center, Department of Radiology, One Medical Center Drive, Lebanon, NH 03756; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.