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MRI Characteristics of Pathological Compression Fractures

MRI Characteristics of Benign Compression Fractures

Posterior body wall

May be convex or disrupted

Usually normal

T1, T2 signals of posterior elements

Frequently abnormal

Normal

Epidural or paraspinal soft tissue infiltration

May be present

Mostly absent

Adjacent vertebral bodies appearance on MRI

Abnormal signals may be observed: T1 decreased, T2 increased

Normal signal characteristics throughout

Management

Past management of compression fractures included analgesic or narcotic medications and immobilization, initially in bed and subsequently in a rigid brace. Patients with refractory pain were frequently managed by prolonged bed rest, which negatively affected the bones as it increased bone breakdown.

Osteoporosis management requires lifestyle changes. Smoking and drinking should be curtailed while fitness and strengthening exercises are advocated. The fractures should be initially immobilized with a proper-fitting brace in order to prevent further collapse. When the pain subsides, high-intensity resistance training exercises should be prescribed. Upper extremity, lower extremity, and spinal extensor muscles should be engaged. It has been shown that the severity of the thoracic kyphosis may be influenced by back extensor strength and that strong back extensors may ameliorate or prevent spinal deformity even in the presence of decreased bone density. These exercises should be combined with general conditioning and fitness exercises.

The introduction of vertebroplasty and kyphoplasty has allowed early painless mobilization in many patients. In both procedures, poly-methylmethacrylate, a form of cement that sets quickly in an exothermic reaction, is injected percutaneously into the fractured vertebral body. The difference between the two procedures is that in kyphoplasty a balloon is introduced into the vertebral body and is then inflated. The inflated balloon restores some of the vertebral height prior to the introduction of cement and thus has the ability to decrease or prevent altogether the development of a kyphotic deformity. Following extraction of the balloon, cement is injected into the space it created (Figures 10-11 and 10-12). Better results can be obtained when ver-tebroplasty and kyphoplasty are performed rather early, preferably in the first 2-3 weeks of fracture occurrence. When these procedures are delayed, the crushed vertebrae heal in situ and the treatment results may not be as effective. These procedures are less effective in vertebrae that have lost over 70% of their height. The major advantages of these

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