title: Significance of preoperative MRI in establishing levels of augmentation for percutaneous vertebroplasty.
abstract: OBJECTIVE
  To determine whether X-ray, computed tomography (CT), bone scan, and clinical impression accurately reflect the level of vertebral fracture in patients about to undergo vertebroplasty.
  
  
  METHODS
  Retrospective observational study, utilizing patient inpatient notes, referral correspondence, and clinicians' private notes.
  
  
  METHODS
  Single center - all patients referred to one pain medicine physician for vertebroplasty who subsequently had the procedure.
  
  
  METHODS
  All patients referred to a pain physician (PJG) over a 4-year period, who had a presumptive diagnosis of vertebral fracture(s) from the referring consultant physician, based on imaging other than magnetic resonance imaging (MRI) and clinical impression. Participants then had an MRI and subsequent vertebroplasty under the care of the pain physician. Participants were identified retrospectively from the vertebroplasty procedure list.
  
  
  METHODS
  Nil.
  
  
  METHODS
  Number of cases in which the MRI identified a different level of pathology than X-ray, CT, bone scan, and clinical impression.
  
  
  RESULTS
  In 50% (28/56) of patients MRI identified a fracture at a different level to that which was presumed to be the cause of patient pain on the basis of X-ray, CT, and clinical impression.
  
  
  CONCLUSIONS
  MRI is an essential investigation to determine accurately the level of fracture in osteoporotic patients. Studies on the effectiveness of treatment of vertebral fractures that do not utilize MRI in every case are unlikely to be accurate.
authors.affiliation: Cambridge Pain Management, Wembly, WA, Australia.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Graziotti
authors.forename: Cherie R
authors.initials: CR
authors.lastname: Graziotti
authors.forename: Adele M
authors.initials: AM
authors.lastname: Sangster
keywords: back pain; crush fracture; osteoporosis; vertebroplasty