Value of Bone Scan Imaging in Predicting Pain Relief from Percutaneous Vertebroplasty in Osteoporotic Vertebral Fractures
A. Stanley Maynarda,
Mary E. Jensena,
Patricia A. Schweickerta,
William F. Marxa,
John G. Shorta and
David F. Kallmesa,b
a From the Department of Radiology (M.E.J., P.A.S., W.F.M., J.G.S., D.F.K.), University of Virginia Health Services, Charlottesville, VA, and Marshall University School of Medicine (A.S.M.), Huntington, WV.
b Address reprint requests to David F. Kallmes, MD, Box 800170, Department of Radiology, University of Virginia Health Services, Charlottesville, VA 22908.
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FIG 1. Images from the case of a 79-year-old man who presented with a history of back pain of several months' duration. Although the patient complained of mid and low back pain, he did not experience localizing pain during physical examination.
A, Lateral view plain film radiograph of the thoracic spine shows wedge compression fracture at T11 (arrow).
B, Lateral view plain film radiograph of the lumbar spine shows wedge compression fractures at L4 (arrow) and endplate compression fractures of L1, L2, and L3.
C, Posterior planar Tc99m-MDP bone scan image shows markedly increased activity at L4 (large arrow) and minimal increased activity over the pedicles or facets of T11 (small arrows). Based on increased activity over L4 and relative lack of increased activity at other fracture sites, we proceeded with a single-level vertebroplasty at L4.
D, Lateral view plain film radiograph of the lumbar spine after vertebroplasty shows barium-opacified methylmethacrylate within the L4 vertebral body (arrow). The patient experienced complete pain relief after treatment. Before treatment, the patient's mobility was limited to walking with assistance. After treatment, he was able to walk without assistance.
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FIG 2. Images from the case of a 77-year-old man who presented with back pain of 3 months' duration.
A, Lateral view plain film radiograph obtained over the lumbar spine shows fractures at L1–L5. No previous images were available to date the onset of fracture at any level. However, because the patient experienced focal tenderness over the spinous processes of L2 and L3 without tenderness over the other fracture levels, we elected to proceed with vertebroplasty at L2 and L3, without performing preprocedural bone scan imaging.
B, Postprocedural lateral view plain film radiograph obtained over the lumbar spine shows barium-opacified methylmethacrylate within the L2 and L3 vertebral bodies. Cement injection at L3 traversed the entire marrow cavity. Cement selectively traversed the superior endplate region at L2, which is commonly seen as the cement naturally extends into fracture lines. Subjectively, the patient improved "about 50 percent," but he requested further treatment, if possible. Bone scan imaging was performed because of uncertainty regarding further therapy.
C, Posterior planar Tc99m-MDP2 bone scan shows increased activity in the region of the L2 fracture (arrow). Based on the bone scan image, which suggested ongoing bone turnover in L2, we selectively targeted the inferior aspect of L2 for the second vertebroplasty treatment.
D, Postprocedural lateral view plain film radiograph shows barium-opacified methylmethacrylate within the inferior aspect of L2 (curved arrows). The patient noted complete pain relief after the second vertebroplasty at L2, stating that he felt "the best he has felt in years."
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