Back pain and its related imaging in osteoporotic patients.

Abstract

In osteoporotic patients acute and severe back pain usually originates from vertebral compression fractures, and chronic one most commonly from an alteration in the supporting mechanism of the spine caused by vertebral body fractures. On MR images the signal intensity of the fractured vertebral bodies generally alter low on T1WI and high on T2WI in the acute phase. This changes in signal intensity are so highly sensitive to detect an additional fresh vertebral fracture in a patient with many prevalent vertebral deformities. Nonunion of vertebral body fracture is one of the causes of chronic back pain in osteoporotics, and it is likely to occur by an inadequate management in the acute phase of a fracture. A fracture line of nonunion is more readily recognized on extension x-ray films of the spine, and MR images also clearly demonstrate nonunion as a low signal intensity area on T1WI and definitely high on T2WI. Gd-enhancement is also useful to evaluate viability of the fracture site, and to predict the fracture healing process. Accordingly, osteoporotic vertebral body fractures are successfully treated by an adequate external fixation devices including a body cast and/or a long brace with reference to MR images additionally to X-ray findings.