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. This modality can also be helpful in patients who have surgical hardware from prior spinal surgical intervention to evaluate the spinal canal at the involved level. MRI Spine Area of Interest Fluid-sensitive MRI sequences (short tau inversion recovery or fat-saturated T2-weighted imaging) help detect new acute adjacent level fractures after VCF treatment. MRI can also show the presence of procedure-related complications that can result in new pain in a treated patient, including epidural or paraspinal hematomas, infection in or around the treated level(s), spinal canal compression, and cord injury/ischemia [79]. A cerebrospinal fluid leak or pseudomeningocele formation is also well depicted with MRI [80]. IV contrast can add information in a posttreatment scan, especially to evaluate for any infection/inflammation in or adjacent to the spinal canal but it should be noted that sometimes a rind of enhancement maybe seen around the bone cement in treated vertebra due to reactionary changes and mild inflammatory response induced by polymethylmethacrylate. Bone Scan Whole Body Tc-99m whole-body bone scan (bone scintigraphy) may be helpful to determine the painful vertebrae [52], particularly the causative level [53,54]. Bone scan and MRI have higher concordance with single-level fractures compared with multiple-level involvement [55]. When more than one area of increased activity is detected, bone scans may overestimate the number of acute fractures. As such, multiple regions of radiotracer accumulation should be interpreted cautiously [56]. The utilization of bone scans may be based on institutional preference.
Management of Vertebral Compression Fractures PCAs. 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. This modality can also be helpful in patients who have surgical hardware from prior spinal surgical intervention to evaluate the spinal canal at the involved level. MRI Spine Area of Interest Fluid-sensitive MRI sequences (short tau inversion recovery or fat-saturated T2-weighted imaging) help detect new acute adjacent level fractures after VCF treatment. MRI can also show the presence of procedure-related complications that can result in new pain in a treated patient, including epidural or paraspinal hematomas, infection in or around the treated level(s), spinal canal compression, and cord injury/ischemia [79]. A cerebrospinal fluid leak or pseudomeningocele formation is also well depicted with MRI [80]. IV contrast can add information in a posttreatment scan, especially to evaluate for any infection/inflammation in or adjacent to the spinal canal but it should be noted that sometimes a rind of enhancement maybe seen around the bone cement in treated vertebra due to reactionary changes and mild inflammatory response induced by polymethylmethacrylate. Bone Scan Whole Body Tc-99m whole-body bone scan (bone scintigraphy) may be helpful to determine the painful vertebrae [52], particularly the causative level [53,54]. Bone scan and MRI have higher concordance with single-level fractures compared with multiple-level involvement [55]. When more than one area of increased activity is detected, bone scans may overestimate the number of acute fractures. As such, multiple regions of radiotracer accumulation should be interpreted cautiously [56]. The utilization of bone scans may be based on institutional preference.