![]() With a transpedicular approach bilaterally, a total of 4.3 mL of cement was injected through a 13-gauge needle into the vertebral body. Because the patient was requiring intravenous narcotic administration, he was sent to the department of neuroradiology for a T7 vertebroplasty. Manual palpation of the T7 spinous process under fluoroscopy demonstrated severe focal pain at this level. MR imaging of the thoracic spine demonstrated a compression fracture of the T7 vertebral body with a 20% loss in height but no significant edema ( Fig 2 A, -B). During the previous week, his pain had become more severe, and he was requiring intravenous narcotics. The patient had fallen from a horse 6 months earlier, resulting in midback pain during this time course, which was rated as 8 of 10, for which he was taking oral narcotics. Because of long-term intravenous antibiotic treatments, he has not been considered a candidate for vertebroplasty during the intervening 6 weeks since his initial evaluation.Ī 47-year-old man with multiple myeloma presented for vertebroplasty evaluation for severe back pain. The patient subsequently underwent bone marrow transplantation and developed multiple severe pulmonary and dermatologic infections. Because the patient’s pain was improving on pain medications, he elected to defer vertebroplasty. Despite the short imaging interval, no edema was present on the MR imaging examination at the L2 level. There was, however, a new fracture at the L2 level ( Fig 1 A, - B). The previously documented fractures had not changed significantly in the interim. He returned 27 days later for a follow-up evaluation, at which time repeat MR imaging was performed. Because it was difficult to clinically localize the specific levels involved, he elected to delay vertebroplasty and attempt a trial of narcotics. He was evaluated initially for vertebroplasty with an MR imaging of the spine, which showed compression fractures at multiple thoracic and lumbar levels. We present 2 patients with multiple myeloma in whom no edema was detected on MR imaging, despite clinical and imaging criteria for an acute or subacute vertebral compression fracture.Ī 64-year-old man with multiple myeloma presented with severe diffuse back pain. Bone scintigraphy generally reveals increased radiotracer uptake in a linear fashion within the involved vertebral body. The visualized edema can be enhanced with the use of fat-saturated T2 techniques. This edema is manifested as increased T2 and decreased T1 signal intensity. MR imaging generally shows loss of vertebral body height as well as edema in the involved vertebra. Confirmation of a compression fracture is typically performed with MR imaging or bone scintigraphy. 1– 3 Although benign osteoporosis is the most common cause of compression fractures, multiple myeloma is another common contributor. Several studies have documented the effectiveness of vertebroplasty in alleviating the pain associated with acute or subacute compression fractures. In recent years, the use of percutaneous vertebroplasty for the treatment of vertebral fractures has become very common.
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