Algorithms for patient selection and VCF management have been proposed by multidisciplinary groups that include oncology, surgery, and interventional radiology, based on evidence and expert opinion for managing metastatic spinal disease [81]. Medical therapy, including bisphosphonates for osteoclast inhibition [82-84] and osteoclast regulating agents [85-87], can be used to prevent skeletal-related events. CT Spine Area of Interest CT provides osseous details of axial spine fractures before VA [12,39]. 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, epidural extension, and spinal canal compression [12,39]. Comparison to prior imaging is helpful to determine acuity. The presence of lobulated paraspinal masses with involvement of both vertebral body and posterior elements at the same time favors malignant involvement [66]. CT is fast and can be used to evaluate a patient with new back pain after undergoing single- or multiple-level VCFs. 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]. Performing contrast-enhanced CT does not add much to the information already available. MRI Spine Area of Interest MRI can provide valuable information in the assessment of VCFs in patients with a history of malignancy or atypical clinical features. In addition to detecting metastases localized entirely in the bone marrow cavity, MRI can be used to differentiate benign from malignant fractures, because osteoporotic VCFs can occur in patients with malignancy [66,67,70,88,89]. MRI allows assessment of the degree of thecal sac or spinal cord compression, epidural tumor extension [16], paraspinal tumor extension, presence of other lesions, and lesion vascularity.
Management of Vertebral Compression Fractures PCAs. Algorithms for patient selection and VCF management have been proposed by multidisciplinary groups that include oncology, surgery, and interventional radiology, based on evidence and expert opinion for managing metastatic spinal disease [81]. Medical therapy, including bisphosphonates for osteoclast inhibition [82-84] and osteoclast regulating agents [85-87], can be used to prevent skeletal-related events. CT Spine Area of Interest CT provides osseous details of axial spine fractures before VA [12,39]. 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, epidural extension, and spinal canal compression [12,39]. Comparison to prior imaging is helpful to determine acuity. The presence of lobulated paraspinal masses with involvement of both vertebral body and posterior elements at the same time favors malignant involvement [66]. CT is fast and can be used to evaluate a patient with new back pain after undergoing single- or multiple-level VCFs. 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]. Performing contrast-enhanced CT does not add much to the information already available. MRI Spine Area of Interest MRI can provide valuable information in the assessment of VCFs in patients with a history of malignancy or atypical clinical features. In addition to detecting metastases localized entirely in the bone marrow cavity, MRI can be used to differentiate benign from malignant fractures, because osteoporotic VCFs can occur in patients with malignancy [66,67,70,88,89]. MRI allows assessment of the degree of thecal sac or spinal cord compression, epidural tumor extension [16], paraspinal tumor extension, presence of other lesions, and lesion vascularity.