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Journal of Korean Neurosurgical Society 2001;30(7): 907-915.
The Value of Preoperative MRI and Bone Scan in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures.
Se Hyuk Kim, Wan Su Lee, Eui Kyo Seo, Yong Sam Shin, Ho Yeol Zhang, Pyoung Jeon
1Department of Neurosurgery, National Health Insurance Medical Center, Ilsan Hospital, Koyang, Korea.
2Department of Diagnostic Radiology, National Health Insurance Medical Center, Ilsan Hospital, Koyang, Korea.
Percutaneous vertebroplasty is often complicated by the presence of multiple fractures or non-localizing pain in the patients with osteoporotic vertebral fractures. The purpose of this study is to estimate the value of preoperative radiologic studies in the localization of symptomatic vertebrae and to determine the factors which can influence on the clinical results. MATERIALS AND METHODS: We retrospectively reviewed the clinical and radiologic data of 57 vertebrae in 30 patients underwent percutaneous vertebroplasty for osteoporotic vertebral compression fractures. Inclusion criteria was severe pain(McGill-Melzack score 3, 4 or 5) associated with the acute vertebral fractures and absence of spinal nerve root or cord compression sign. Acute symptomatic vertebral fracture was determined by the presence of signal change on MR images or increased uptake on whole body bone scan.
Pain improvement was obtained immediately in all patients and favorable result was sustained in 26 patients(86.7%) during the mean follow-up duration of 4.7 months(5 complete pain relief, 21 marked pain relief). Those who underwent vertebroplasty for all acute symptomatic vertebrae had significantly better clinical result than those who did not. Further vertebral collapse and eventual bursting fracture occurred in 1 vertebra which showed intradiskal leakage of bone cement and disruption of cortical endplate on postoperative CT scan.
Preoperative MR imaging and whole body bone scan are very useful in determining the symptomatic vertebrae, especially in the patients with multiple osteoporotic vertebral fractures. To obtain favorable clinical result, the careful radiologic evaluation as well as clinical assessment is required. Control of PMMA volume seems to be the most critical point for avoiding complications.
Key Words: Vertebroplasty; Osteoporotic compression fracture; Spinal MRI; Whole body bone scan
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