The role of bone scintigraphy in treatment planning, and predicting pain relief after kyphoplasty.
BACKGROUND
The role of whole-body Tc-MDP bone scanning in the management of vertebral compression fractures with kyphoplasty has not been clearly established.


OBJECTIVE
To determine the accuracy of bone scanning in patient selection, planning treatment and predicting response to kyphoplasty.


METHODS
Retrospective chart reviews were undertaken of all kyphoplasties performed by the same orthopaedic surgeon between June 2000 and June 2004. All patients who underwent plain radiographs (X-ray) of the spine and bone scanning within 4 weeks of treatment were included. Response to treatment was assessed via a questionnaire administered to the patient 3 weeks after intervention and concomitant objective assessment. Response was graded as excellent, intermediate or poor. Each bone scan was reviewed by two nuclear physicians blinded to the initial scan results, level of treatment and therapeutic response. The readers were asked to indicate the level(s) to be treated according to the bone scan findings. Sites of chronic fractures were also recorded.


RESULTS
Sixty-six procedures on 60 patients fulfilled the selection criteria. Fifty-three patients were managed by X-ray and bone scanning (A) and seven were managed by X-ray only (B). There was a significant difference in the rates of sub-optimal results between (A) and (B) (11/53 vs. 7/7, P=0.0001). There was also a significant difference in chronic fracture rates between patients with excellent outcome and those with sub-optimal results (3/42 vs. 7/11, P=0.0002). A high rate of incorrect level selection (3/7) was found in (B). In 12 patients (20%) X-ray showed multiple fractures but the bone scanning demonstrated only one level of acute disease.


CONCLUSIONS
Bone scanning is an excellent predictor of response to kyphoplasty and decreases the number of vertebrae to be treated as suggested by X-ray. Preoperative bone scanning is recommended to avoid incorrect selection of treatment level. Even when the appropriate level has been selected an incomplete response can be expected if additional chronic fracture is seen on bone scanning. In the event of unexpected incomplete response, re-evaluation with bone scanning may demonstrate new disease amenable to therapy.
Karam
Maroun
M
Division of Nuclear Medicine, Albany Medical College, 1367 Washington Avenue, Albany, NY 12206, USA.
Lavelle
William F
WF
Cheney
Robert
R
D000368:Aged; D005260:Female; D050815:Fractures, Compression / Q000150:complications / Q000628:therapy; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010146:Pain / Q000209:etiology* / Q000517:prevention & control*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000150:complications* / Q000628:therapy*; D013669:Technetium Tc 99m Medronate; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D016896:Treatment Outcome; D054854:Vertebroplasty
D019275:Radiopharmaceuticals; D013669:Technetium Tc 99m Medronate