CT permits evaluation of vertebral body height, architecture, and integrity of the posterior cortex and pedicles before VA, which is critical in patients with cortical disruption, posterior cortex osseous retropulsion, and spinal canal compression. Comparison to prior imaging is helpful to determine acuity. Dual-energy CT may show bone marrow edema with reasonably high sensitivity and specificity [40,41] and good concordance to MRI in thoracolumbar VCFs [42]. Intravenous (IV) contrast does not provide additional value in this clinical scenario. Vertebral Compression Fractures CT Myelography Spine Area of Interest CT myelography is not routinely used for evaluating benign VCFs unless the patient has a neurologic deficit with suspected spinal canal compression. MRI Spine Area of Interest MRI may provide valuable information to determine the need for intervention and procedural guidance. The benefits of MRI for preprocedural planning have been reported [43-45]. Minimally deforming fractures that may not be well seen on conventional radiographs may be better detected on preprocedure MRI, mainly if the imaging evaluation is >3 months since the suspected injury or if there is a change in symptoms from the initial workup [43,46]. Fluid- sensitive MRI sequences (short tau inversion recovery or fat-saturated T2-weighted imaging) help detect and differentiate acute/subacute versus chronic fractures, identifying fracture clefts, and differentiating synchronous fractures [46,47]. MRI is also valuable for distinguishing recent from chronic vertebral fractures in patients with multiple vertebral fractures and diffuse back pain, which can at times confound the clinical examination [48,49]. However, vertebral body edema is not a precise measure of compression fracture age because the duration after an osteoporotic compression fracture is often not known with certainty. Bone marrow edema typically resolves within 1 to 3 months [50,51].
Management of Vertebral Compression Fractures PCAs. CT permits evaluation of vertebral body height, architecture, and integrity of the posterior cortex and pedicles before VA, which is critical in patients with cortical disruption, posterior cortex osseous retropulsion, and spinal canal compression. Comparison to prior imaging is helpful to determine acuity. Dual-energy CT may show bone marrow edema with reasonably high sensitivity and specificity [40,41] and good concordance to MRI in thoracolumbar VCFs [42]. Intravenous (IV) contrast does not provide additional value in this clinical scenario. Vertebral Compression Fractures CT Myelography Spine Area of Interest CT myelography is not routinely used for evaluating benign VCFs unless the patient has a neurologic deficit with suspected spinal canal compression. MRI Spine Area of Interest MRI may provide valuable information to determine the need for intervention and procedural guidance. The benefits of MRI for preprocedural planning have been reported [43-45]. Minimally deforming fractures that may not be well seen on conventional radiographs may be better detected on preprocedure MRI, mainly if the imaging evaluation is >3 months since the suspected injury or if there is a change in symptoms from the initial workup [43,46]. Fluid- sensitive MRI sequences (short tau inversion recovery or fat-saturated T2-weighted imaging) help detect and differentiate acute/subacute versus chronic fractures, identifying fracture clefts, and differentiating synchronous fractures [46,47]. MRI is also valuable for distinguishing recent from chronic vertebral fractures in patients with multiple vertebral fractures and diffuse back pain, which can at times confound the clinical examination [48,49]. However, vertebral body edema is not a precise measure of compression fracture age because the duration after an osteoporotic compression fracture is often not known with certainty. Bone marrow edema typically resolves within 1 to 3 months [50,51].