title: Bone scintigraphy for the diagnosis of the responsible level of osteoporotic vertebral compression fractures in percutaneous balloon kyphoplasty.
abstract: OBJECTIVE
  This study was to investigate the efficacy of bone scintigraphy in order to diagnose the correct level of vertebral compression fractures (VCF) for the severe back pain before balloon kyphoplasty (BKP) was performed.
  
  
  METHODS
  A total of 30 consecutive patients were treated with BKP for 38 times since May 2012. Eleven patients had acute multi-level VCFs. Bone scintigraphy was performed preoperatively except for the first case and the case with a chronic course and the level responsible for the pain was defined with bone scintigraphy. The responsible level of acute single level VCF was easily diagnosed with T1, T2, and fat sat T2 but the responsible level of acute multi-level VCFs was not easily determined. BKP was performed at the most accumulated level on bone scintigraphy and the preoperative and postoperative Visual analogue score (VAS) scores were researched with questionnaire postoperatively.
  
  
  RESULTS
  BKP was effective in relief of pain at the most accumulated level on bone scintigraphy. Preoperative VAS score (average 8.6) was significantly improved at post-ope day1 (average 3.9), at discharge (average 2.4) and at 1 month after discharge (average 2.1). New symptomatic VCFs after the first treatment occurred in 5 patients at an adjacent level in 3 and twice in 2 of 5 and additional BKP was effective in each patient.
  
  
  CONCLUSIONS
  The correct level of symptomatic VCF in the patients with acute multi-level VCFs should be diagnosed to achieve good clinical results. In this study, we showed that bone scintigraphy is very useful in diagnosing the proper level for BKP in addition to CT and MRI.
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro City, Japan; Department of Neurosurgery, Tokushima University, Tokushima City, Japan. Electronic address: tokazaki1978@sirius.ocn.ne.jp.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okazaki
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro City, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakagawa
authors.affiliation: Department of Neurosurgery, Tokushima University, Tokushima City, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Yagi
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro City, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Hayase
authors.affiliation: Department of Neurosurgery, Tokushima University, Tokushima City, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Nagahiro
authors.affiliation: Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital, Kushiro City, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Saito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050815:Fractures, Compression / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D058498:Kyphoplasty / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging* / Q000601:surgery; D011877:Radionuclide Imaging / Q000379:methods*; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000601:surgery
keywords: Balloon kyphoplasty; Bone scintigraphy; Correct diagnosis; Earlier timing; Multi-level fractures; Vertebral compression fracture