Before augmentation, STIR oedema identifies the painful acute fracture; posterior wall retropulsion and pedicle integrity decide safety; after, cement leakage into the canal, foramina, veins or lungs is the complication to report.
Orient first
- Marrow oedema on fluid-sensitive MRI marks an unhealed, likely symptomatic fracture; old fractures without oedema rarely respond.
- Benign osteoporotic vs malignant fracture: posterior element involvement, convex posterior wall, epidural mass and diffuse marrow replacement favour malignancy.
- Cement leakage is common and usually asymptomatic; into the canal or pulmonary arteries it matters.
Acquire the study
- Sagittal T1, STIR, axial T2; post-gadolinium T1 if malignancy suspected.
The manoeuvre
- Sagittal STIR: which vertebrae have marrow oedema.
- Sagittal T1: band-like fracture line (osteoporotic) vs diffuse replacement (malignant).
- Posterior wall: retropulsion in mm; canal compromise.
- Pedicles and posterior elements; epidural or paraspinal soft tissue.
What confirms it
- STIR oedema at a level concordant with pain.
What licenses you to exclude it
- No oedema on STIR makes augmentation unlikely to help.
The classic misread
- Treating a chronic fracture without oedema.