Abstract
Purpose To determine the utility of MR STIR imaging findings relative to fluoroscopic exam in the efficacy of treating vertebral compression fractures due to multiple myeloma. Materials and Methods Ten consecutive MM patients from a single center with vertebral compression fractures refractory to conservative treatment were treated with kyphoplasty. After a thorough review of pre-procedure magnetic resonance imaging (MRI), fluoroscopic examination of the spine was performed. Demographic, clinical, and procedural data on patients were retrospectively analyzed. Primary measure of outcome was pain relief and functional status, as assessed by the pre and post-procedure Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Paired-Samples T test was used for comparison of pre and post measures of outcome. Results Ten patients with refractory back pain representing 36 levels of vertebral compression by MRI were evaluated for potential kyphoplasty. After fluoroscopic assisted palpation of the spine eliciting a moderate to severe pain-response, the ten patients represented 18 treated vertebral levels. A review of the MRI findings of the treated levels showed the absence of traditional MR signal finding of marrow edema; and had little utility in guiding therapy at the time of exam. All patients experienced significant improvement in pain score as measured by VAS. The mean pre and post-procedure VAS were 6.8 and 1.3 (p=0.001), respectively. All patients experienced significant improvement in there functional ability as measured by their ODI questionnaire. Mean pre and post-procedure ODI were 51.4 and 29.8, (p=0.001), respectively. Conclusion Solely relying on MRI alone to determine who may benefit from vertebral augmentation is not sufficient, and often may preclude a patient’s potential to gain significant benefit if treatment is withheld due to the absence of traditional MR STIR imaging findings of bone marrow edema. Symptomatic levels may be missed due to the presence of multilevel, heterogeneous MR signal abnormalities in multiple myeloma, but by using a clinical-based approach and utilizing the fluoroscopic exam, excellent results may be achieved, which is critical to palliative success.
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