title: Prediction of immediate and long-term benefit after kyphoplasty of painful osteoporotic vertebral fractures by preoperative MRI.
abstract: BACKGROUND
  It is unclear if an MR-detectable bone marrow edema is a prerequisite for pain reduction and morphological correction by kyphoplasty. This comparative trial evaluates clinical and radiomorphological outcomes after kyphoplasty of painful osteoporotic vertebral fractures with and without preoperative MR-detectable bone marrow edema for 1 year of follow-up.
  
  
  METHODS
  Preoperative MR-images of 45 patients who received kyphoplasty for treatment of painful osteoporotic vertebral fractures were evaluated with regard to presence (n = 27) or absence (n = 18) of vertebral bone marrow edema. Pain scores (VAS 0-100) and radiomorphological measures (midline vertebral height, kyphosis angle) were analysed at baseline, postoperatively and after 12 months.
  
  
  RESULTS
  In the "bone edema" group, pain scores improved from 72.7 to 46.8 (postoperative) and 48.0 (12 months, P < 0.001, both). In the group without preoperative bone edema, pain score improved from 70.7 to 60.3 (postoperative, P = 0.013) and to 50.1 (12 months, P = 0.001). Pain scores of both groups were significantly different directly postoperative (P = 0.026), but not after 12 months (P = 0.714). Vertebral height restoration was slightly greater in the "bone edema" group (10.2% vs. 7.8%, P = 0.289). Correction of the kyphosis angle was greater in the "bone edema" group (P = 0.014) compared to the "no bone edema" group (P = 0.838).
  
  
  CONCLUSIONS
  A preoperative MR-detectable vertebral bone marrow edema predicts a better short-term outcome after kyphoplasty, but is not a prerequisite for long-term pain reduction in patients with old, chronically painful osteoporotic vertebral fractures.
authors.affiliation: Division of Osteology, Department of Medicine I and Clinical Chemistry, Ruprecht-Karls-University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: I A
authors.initials: IA
authors.lastname: Grafe
authors.affiliation: Department of Radiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Nöldge
authors.affiliation: Department of Biostatistics, Faculty of Clinical Medicine Mannheim, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Department of Radiology, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Libicher
authors.affiliation: Department of Orthopedic Surgery, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Baier
authors.affiliation: Division of Osteology, Department of Medicine I and Clinical Chemistry, Ruprecht-Karls-University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Nawroth
authors.affiliation: Department of Orthopedic Surgery, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
authors.forename: P-J
authors.initials: PJ
authors.lastname: Meeder
authors.affiliation: Department of Orthopedic Surgery, University of Heidelberg, INF 410, 69120, Heidelberg, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Wiedenhöfer
authors.affiliation: Division of Osteology, Department of Medicine I and Clinical Chemistry, Ruprecht-Karls-University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Christian.Kasperk@med.uni-heidelberg.de.
authors.forename: C
authors.initials: C
authors.lastname: Kasperk
keywords: Back pain; Bone marrow edema; Kyphoplasty; MRI; Vertebral fracture
references.citation: Unfallchirurg. 2001 Jun;104(6):488-97
references.pmid: 11460453
references.citation: Osteoporos Int. 2001;12(6):429-37
references.pmid: 11446557
references.citation: Osteoporos Int. 2005 Dec;16(12 ):2005-12
references.pmid: 16078092
references.citation: Eur Spine J. 2004 Oct;13(6):496-501
references.pmid: 15083353
references.citation: J Bone Miner Res. 2005 Apr;20(4):604-12
references.pmid: 15765179
references.citation: Spine (Phila Pa 1976). 2001 Jul 15;26(14):1631-8
references.pmid: 11464159
references.citation: AJNR Am J Neuroradiol. 2006 Aug;27(7):1579-85
references.pmid: 16908585
references.citation: Spine (Phila Pa 1976). 2006 Jan 1;31(1):57-64
references.pmid: 16395177
references.citation: Spine (Phila Pa 1976). 2001 Jul 15;26(14):1511-5
references.pmid: 11462078
references.citation: AJR Am J Roentgenol. 2005 Jun;184(6):1951-5
references.pmid: 15908560
references.citation: Spine (Phila Pa 1976). 2003 Oct 1;28(19):2260-5; discussion 2265-7
references.pmid: 14520041
references.citation: Eur Spine J. 2007 Aug;16(8):1085-100
references.pmid: 17277923
references.citation: J Neurosurg. 2003 Jul;99(1 Suppl):44-50
references.pmid: 12859058
references.citation: J Orthop Trauma. 2004 May-Jun;18(5):294-9
references.pmid: 15105751
references.citation: Spine J. 2004 Jul-Aug;4(4):418-24
references.pmid: 15246303
references.citation: Neuroradiology. 2008 Feb;50(2):153-9
references.pmid: 17909775
references.citation: Spine (Phila Pa 1976). 2005 Nov 1;30(21):2430-5
references.pmid: 16261121
references.citation: J Vasc Interv Radiol. 2010 May;21(5):701-9
references.pmid: 20304677
references.citation: AJNR Am J Neuroradiol. 2000 Nov-Dec;21(10 ):1807-12
references.pmid: 11110531
references.citation: Radiology. 2006 Apr;239(1):195-200
references.pmid: 16493017
references.citation: Eur Spine J. 2009 Sep;18(9):1287-92
references.pmid: 19504131