Abstract No. 57 - How often does advanced imaging change management prior to vertebral augmentation? A retrospective review of 292 cases

Abstract

To examine the frequency with which a pre-procedural MRI or nuclear medicine bone scan alters the treatment plan when compared with plain films and/or CT prior to vertebral augmentation procedures. We retrospectively reviewed 292 vertebral augmentations (kyphoplasty or vertebroplasty) performed at a single hospital between May of 2013 and August of 2016. Preprocedure imaging of the spine obtained within the 30 days prior to the procedure (x-rays, CT, nuclear medicine bone scan, or MRI) was reviewed for each patient encounter. Pre-procedure imaging results were cross-referenced against the levels treated by vertebral augmentation to determine whether there was a change in the levels treated after receiving an advanced imaging study such as MRI or bone scan in addition to initial x-rays and/or CT. Patients were subdivided into 2 categories according to the combination of pre-procedure imaging received: Those who received x-rays and/or CT along with MRI and/or bone scan, and those who received only one category or the other. Of the 292 vertebral augmentations performed, 205 patients (69.9%) had a CT and/or x-ray of the affected spine followed by a more advanced study such as an MRI or bone scan to evaluate for acuity of fractures prior to their vertebral augmentation procedure. In patients that had both categories of studies, findings on MRI or bone scan changed the levels treated in 53.2% of the cases (109 out of 205 cases). MRI and/or bone scan findings correlated with x-ray and/or CT findings in only 46.8% of cases. MRI or nuclear medicine bone scan imaging prior to vertebral augmentation alters the location and number of levels treated in a large percentage of patients treated with vertebral augmentation, adding specificity to treatment over findings on plain film or CT alone. Therefore, patients who do not receive more advanced imaging to assess for the acuity of fractures may be incompletely treated, or treated unnecessarily.