In the STIR image the acute T5 fracture shows high signal (edema) which is not seen in the chronic T7 and T12 fractures.
In patients who are unable to have an MR due to the presence of a pacemaker or other metallic device, an x-ray or CT combined with a bone scan is often able to differentiate between acute or subacute and chronic fractures.
Vertebroplasty is a safe and effective procedure for patients with painful osteoporotic vertebral body fractures. During the procedure, a trocar is advanced through the pedicle into the anterior vertebral body under fluoroscopic guidance, and methylmethacrylate cement containing barium (for radiographic visualization) is slowly infused. Vertebroplasty has consistently shown an immediate and significant improvement in pain associated with osteoporotic vertebral body fractures. An associated improvement in mobility compared to conservative treatment has also been demonstrated, as well as decreased requirement for narcotic analgesia, with the expected improvement in long-term clinical outcomes.
Jensen ME et al. Position statement on percutaneous vertebral augmentation: a consensus statement developed by the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. AJNR Am J Neuroradiol. 2007 Sep; 28:1439-43.
Dittmer DK et al. Complications of immobilization and bed rest. I. Musculoskeletal and cardiovascular complications. Can Fam Physician 1993; 39:1428-32,1435-37.
Do HM et al. Percutaneous vertebroplasty versus medical therapy for treatment of acute vertebral body fractures: a prospective randomized study. Proceedings of the Annual Meeting of the American Society of Neuroradiology, Vancouver, BC, Canada, May 2, 2002.
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