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12-08-2010 | Bone health | Article

SuLR suitable alternative to MRI for detecting IVC in patients with VCF

Abstract

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MedWire News: Supine lateral radiographs (SuLR) are a suitable alternative to magnetic resonance imaging (MRI), and superior to standing lateral radiographs (StLR), for detecting intravertebral cleft (IVC) in patients with severely collapsed vertebral compression fracture (VCF), suggest study findings.

Yen-Yao Li (Chang Gung Memorial Hospital, Puzi City, Taiwan) and colleagues performed the study as they had previously observed that the vertebral height (VH) of severely collapsed VCFs increased on SuLR compared with StLR.

The current findings are therefore of clinical importance as VCFs that show severe vertebral body collapse to less than one-third of its original height are considered as a contraindication for vertebroplasty.

Included in the study were 37 patients (aged 50-93 years) with 40 symptomatic osteoporotic VCFs for vertebroplasty, of whom 11 had severely collapsed VCFs with concurrent IVCs detected on the SuLR.

One week before surgery, StLR, SuLR, and MRI were performed on all patients. Postoperative StLR was performed to evaluate VH restoration and regional kyphosis compared with preoperative StLR. Pain intensity was assessed using the visual analogue scale (VAS) on the day prior to surgery and 1 day, 1 month, and 4 months postoperatively.

The researchers found that IVCs among 29 not severely collapsed VCFs were detected in 21 vertebrae (72.4%) by MRI, in 15 vertebrae (51.7%) by SuLR, and in seven vertebrae (24.1%) by preoperative StLR.

Compared with MRI - the gold standard for detecting IVCs - SuLR was over two-fold more sensitive for detecting IVCs than StLR, at 71% versus 33%, respectively.

The team says that "SuLR may be a cost-effective tool before performing a MRI study to select those candidates for vertebroplasty who present with severely collapsed osteoporotic VCFs with IVCs."

The researchers also found that in patients with VCFs with IVCs detected on SuLR, the average postoperative restoration in VH ratio was significantly higher than in those without IVCs, at 17.1% versus 6.4%, respectively.

No difference in VAS scores was seen between patients with severely and not-severely collapsed VCFs.

Writing in the journal BMC Musculoskeletal Disorders, Li and team conclude: "We suggest that severely collapsed VCFs with an IVC seen on the SuLR can have good results regarding pain relief compared with not-severely collapsed VCFs, once intravertebral stability has been achieved by vertebroplasty."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Ingrid Grasmo

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