Significance of preoperative MRI in establishing levels of augmentation for percutaneous vertebroplasty

OBJECTIVES: To determine whether X-ray, computed tomography (CT), bone scan, and clinical impression accurately reflect the level of vertebral fracture in patients about to undergo vertebroplasty. DESIGN: Retrospective observational study, utilizing patient inpatient notes, referral correspondence, and clinicians’ private notes. SETTING: Single center – all patients referred to one pain medicine physician for vertebroplasty who subsequently had the procedure. PARTICIPANTS: All patients referred to a pain physician (PJG) over a 4-year period, who had a presumptive diagnosis of vertebral fracture(s) from the referring consultant physician, based on imaging other than magnetic resonance imaging (MRI) and clinical impression. Participants then had an MRI and subsequent vertebroplasty under the care of the pain physician. Participants were identified retrospectively from the vertebroplasty procedure list. INTERVENTION: Nil. MAIN OUTCOME MEASURE: Number of cases in which the MRI identified a different level of pathology than X-ray, CT, bone scan, and clinical impression. RESULTS: In 50% (28/56) of patients MRI identified a fracture at a different level to that which was presumed to be the cause of patient pain on the basis of X-ray, CT, and clinical impression. CONCLUSION: MRI is an essential investigation to determine accurately the level of fracture in osteoporotic patients. Studies on the effectiveness of treatment of vertebral fractures that do not utilize MRI in every case are unlikely to be accurate.