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Magnetic resonance neurography indicated bilateral insufficiency fractures of sacral ala and right parasymphyseal pubic body

Jul 2013
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Answered by

Orthopaedic Surgeon, Joint Replacement
Practicing since : 1996
Answered : 2148 Questions
An MRI of the lumbar and sacral spine did not correlate with my symptoms, tremendous sacral pain and sciatic nerve pain. Finally, I was able to obtain a magnetic resonance neurography that indicated bilateral insufficiency fractures of of sacral ala and the right parasymphyseal pubic body. The doctor treating me with Forteo, who doesn't communicate with patients, wants me to have an MRI prior to my visit with him three months after starting Forteo. Will the MRI show whether the fractures are healing or will the MRI be as useless as the first one that I had that didn't show any problems?
Posted Sun, 17 Nov 2013 in Brain and Spine
Answered by Dr. K. Naga Ravi Prasad 2 hours later
Brief Answer:
Plain Xrays are best predictors of bone union.

Detailed Answer:
Hi, thanks for writing to XXXXXXX

Forteo (Teriparatide) is a synthetic recombinant parathyroid hormone that works to INCREASE the new bone formation especially in postmenopausal women who are at high risk of fractures.

MRI scan of the involved area will definitely show up the status of the fracture union but plain Xray of the sacrum is more than sufficient to assess the fracture union.

The most simplest of all, in assessing the fracture union is the ABSENCE OF TENDERNESS (pain on deep pressure) over the fractured area.
If you still experience any pain with pressure over the fracture area, it indicates that the fracture is still consolidating and not yet healed fully.

Hope I have addressed your query. Happy to help further

Above answer was peer-reviewed by
Follow-up: Magnetic resonance neurography indicated bilateral insufficiency fractures of sacral ala and right parasymphyseal pubic body 11 hours later

Just wish to suggest that you browse the literature for imaging 'insufficiency fractures'. A radiograph will not show an insufficiency fracture.

And good for you, you did read about Forteo.

My question was if an insufficiency fracture does not show up on an MRI, but does show up on an MRN, will the MRI. Help for a follow up.

Answered by Dr. K. Naga Ravi Prasad 1 hour later
Brief Answer:
Xrays will not show fractures initially.

Detailed Answer:
Hi, this is just to let you know that Insufficiency fractures (stress fractures) cannot be picked up by radiographs, only in the initial phase of the fracture occurance. But, they can be made out on Plain Xrays after about 4-6 weeks after an established Insufficiency fracture (when bone resorption occurs and fracture becomes visible), as a RADIOLUCENT SHADOW lined on either side by sclerotic bone margins. Dedicated High resolution radiographs are needed to diagnose a Stress fracture.

So, MRI scans are helpful in establishing the diagnosis of a Insufficiency fracture, only in the initial phases, when the xrays won't show any abnormality.

MRN is meant for evaluation of nerve root disorders and lesions when the conventional MRI scans are inconclusive. So, MRN is of no help in assessing the insufficiency fractures.

MRI is the best available diagnostic tool for a follow up.

Hope I have justified your query. Good day
Above answer was peer-reviewed by
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