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Case 1: 86 year old woman with acute onset of low back pain
a: Sagittal MR image demonstrates multiple chronic compression fractures along with an acute fracture of L3. The patient was treated with vertebroplasty.	b. Axial CT scan performed after vertebroplasty demonstrates excellent filling of the L3 centrum. The patient experienced relief of symptoms.
Case 2: 84 year old woman with acute onset of low back pain.
a. Sagittal MR image demonstrates a fluid cavity within an acute fracture of L1 representing “avascular necrosis.”	b. An upright lateral chest radiograph demonstrates compression of the L1 vertebral body (outlined). (L1 was of normal height similar to T12 above (outlined) when the patient was in the supine position for the previous MRI study.)
Case 2 (continued)	Case 3: 73 year old woman with history of lung cancer presents with low back pain.
c. The fracture was distracted when the patient was placed prone for the vertebroplasty and the cavity filled with cement restoring original height (outlined).	a. Sagittal screening MRI exam demonstrates a thoracic vertebral fracture typical of osteoporosis rather than metastasis (arrow). The patient was subsequently treated with vertebroplasty.
Case 4: 78 year old woman presents with severe back pain after minimal trauma.
a: Sagittal MR image shows acute compression fractures of T9, T11 and T12.	b: CT scan with coronal reconstruction after successful treatment with vertebroplasty.

Above images are all original MR scans performed at Parkside MR Center.

Osteoporosis affects over 10,000,000 Americans, including 45% of Caucasian women over 50 years of age.¹ The lifetime risk of a woman developing a vertebral compression fracture associated with osteoporosis is greater than 25% and this incidence is expected to dramatically increase with the general aging of the US population.

Osteoporosis frequently affects the spine as a “silent disease” with slow resultant loss in bone density and deformity. Over 700,000 times a year, however, it results in an acute spinal fracture, usually involving the mid-thoracic and lumbar regions. The acute pain syndrome that ensues can result in substantial morbidity and functional deterioration.

MRI is the best method of evaluating patients with acute pain syndrome in whom osteoporotic compression fracture is possible. MRI can accurately assess whether a fracture has occurred and can differentiate osteoporotic fractures from fractures caused by metastatic disease. It can also distinguish acute from chronic fractures and can assess compromise of the spinal canal and nerve roots.

Vertebroplasty is a minimally invasive procedure in which acrylic cement is injected through the pedicles of the affected vertebra using x-ray guidance, thereby affording symptomatic relief of pain. It is effective in treating the pain associated with vertebral compression fractures in up to 90% and has a complication rate of about 1%. Patients usually experience symptomatic relief less than 48 hours after the procedure.

References:
1. LJ Melton. Epidemiology of spinal osteoporosis. Spine 1997;22:2S-11S.

For more information on MRI of vertebral compression fractures and other case studies, call us at 847-696-7900.

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