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. 2006 May;27(5):983-8.

Bone marrow edema in osteoporotic vertebral compression fractures after percutaneous vertebroplasty and relation with clinical outcome

M H J Voormolen  1 , W J van Rooij, Y van der Graaf, P N M Lohle, L E H Lampmann, J R Juttmann, M Sluzewski
Affiliations

Bone marrow edema in osteoporotic vertebral compression fractures after percutaneous vertebroplasty and relation with clinical outcome

M H J Voormolen et al. AJNR Am J Neuroradiol. 2006 May.

Abstract

Background and purpose: Little is known about the evolution of bone marrow edema (BME) in osteoporotic vertebral compression fractures (VCF) after percutaneous vertebroplasty (PV) or about its relation with relief of pain. In this study, we prospectively assessed changes in BME with MR imaging at 3, 6, and 12 months after PV and related changes in BME with pain evolution and analgesic use over time.

Methods: BME percentage was assessed in 64 patients after PV of 89 VCF with serial MR imaging follow-up at 3, 6, and 12 months. Pain was assessed before PV and at every follow-up interval by visual analog scale for pain and type of analgesic used. Relation between changes in BME and pain evolution was assessed in a subgroup of 31 patients with a single treated VCF and neither new VCF at follow-up nor pain at another untreated level.

Results: BME gradually decreased over time. At 1 year after PV, 29% of treated VCF still demonstrated BME. Once BME disappeared, it did not return. Pain relief was most striking the first 3 months after PV and remained constant thereafter. There was no relation between relief of pain and extent, presence, or absence of BME after PV.

Conclusion: A gradual decrease of BME in osteoporotic VCF treated with PV is apparent during 12 months of MR imaging follow-up. Decrease of BME is unrelated to relief of pain.

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Figures

Fig 1.
Fig 1.
Extent of bone marrow edema (BME) in 89 treated vertebral compression fractures before the procedure (0 month) and at follow-up intervals after percutaneous vertebroplasty (PV) in 64 patients.
Fig 2.
Fig 2.
Sagittal short τ inversion recovery (STIR) (A) and T1-weighted image (B) follow-up in a patient with osteoporotic vertebral compression fracture (VCF) T12 treated by percutaneous vertebroplasty (PV). Visual analog score for pain before (0) and at 3, 6, and 12 months after PV: 10, 2, 1, and 1, respectively. Patient used morphine pre-procedure (0) and no pain medication at 3, 6, and 12 months after PV. Percentage bone marrow edema (based on all images) in VCF T12 before (0) and at 3, 6, and 12 months after PV: 75%, 25%, 20%, and 0%, respectively.
Fig 3.
Fig 3.
Small hyperintense rim on sagittal short τ inversion recovery (STIR) and hypointense on T1-weighted image, comparable with the signal intensity of water, directly surrounding the cement cast at 6-month follow-up after PV of VCF L1.
Fig 4.
Fig 4.
Median visual analog scale (VAS) score for pain in 31 patients (subgroup A) before percutaneous vertebroplasty (PV) and at follow-up intervals.
Fig 5.
Fig 5.
Use of analgesics in 31 patients (subgroup A) before percutaneous vertebroplasty (PV) and at follow-up intervals.
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