Back Report: Interventional rads really rely on diagnostic CT and MRI reporting to plan an effective percutaneous vertebral augmentation. As Dr. Monica Cooley warned during ARRS26, missed details can lead to cement leakage, incomplete pain relief, or severe canal compromise. And it’s often a DR’s own dictations that dictate whether a patient is a candidate for procedure, which access trajectory to choose, and just how much cement to safely infuse.
Critical CT Findings
- Fracture Plane Trajectory: Explicitly detail whether fracture lines extend into the posterior cortex or vertebral endplates. These serve as direct channels for cement migration toward at-risk neural structures.
- Intravertebral Clefts: Report fluid- or gas-filled fracture clefts. Bridging these clefts with cement is critical to eliminate pain-causing instability.
- Pedicle Integrity: Highlight the fractures, as well as underlying lytic lesions. Breached or weak pedicles require switching to a unipedicular approach using a curved cannula to avoid cement extrusion.
- Bony Retropulsion: Note retropulsed fragments causing spinal canal stenosis or cord compression. Retropulsion may disqualify the patient or demand a conservative posterior cement volume to prevent neural injury.
Essential MRI Findings
- Marrow Edema (STIR/T1): Confirm active edema along the fractured endplate, signaling inflammation and unhealed fracture motion.
- Healed vs. Acute: Fractures without marrow edema are considered healed and, generally, do not benefit from vertebral augmentation.
- Underlying Path: ID metastases, plasmacytoma, or epidural extension. Significant canal compromise or tumor involvement may redirect care toward surgical decompression or combined radiofrequency ablation with plasty.
RadFYI: A good diagnostic report becomes a great interventional roadmap. Explicitly calling out fracture planes, pedicle breaches, retropulsion, and STIR edema gives proceduralists the best blueprint for safe and targeted cement fill.
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