Utility of bone scintigraphy to determine the appropriate vertebral augmentation levels

Vertebral augmentation procedures have been used as an effective treatment for back pain due to vertebral compression fracture from different causes, including metastatic disease and osteoporosis. However, diagnosis and localization of the causative vertebral level(s) may be difficult using any single imaging modality. In this retrospective study, we assessed the ability of preprocedural bone scans to determine the appropriate level(s) of subsequent vertebroplasty.

The study consisted of a retrospective chart review of 44 patients who underwent bone scintigraphs and vertebroplasties at Montefiore Medical Center from 2002 to 2008. Online medical records and reports were used to determine the level of vertebroplasty and the preprocedure bone scan levels. The data was reviewed by a panel consisting of a neuroradiologist and nuclear medicine physician for agreement.

Our retrospective study assessed the utility of bone scans as a diagnostic tool to identify candidate vertebral levels for vertebroplasty and determined that bone scans were positive in 78.3% of all fractures that subsequently underwent vertebral augmentation procedures. Although no significant difference was seen in the positivity of bone scans to subsequent vertebroplasty levels between benign or metastatic compression fractures (79% vs. 76%), a difference was observed when single level vertebroplasty patients were compared with multiple-level vertebroplasty patients (87% vs. 69%). Our results support the use of whole body bone scintigraphy as a diagnostic tool prior to vertebroplasty, especially in cases where a single vertebral level is involved or MRI might be contraindicated.