We read with interest the JNIS article, ‘The need for thoracic MRI before vertebral augmentation surgery in patients with lumbar vertebral fractures’ by Zhang et al.1 The authors examined 700 patients with known vertebral compression fractures (VCF) between T11 and L5 who also had MRI of the thoracic spine. Their institution’s standard lumbar spine MRI included L5 to T11. They found 91 patients (13.7%) had additional unsuspected thoracic compression fractures at T10 and above, with almost 97% of these occurring between T6 and T10.1 The authors of the study therefore advocate routine MRI of the thoracic spine for patients with lumbar compression fractures who will receive augmentation.

It is not rare in a busy spine intervention practice for a patient not to improve as expected following augmentation, only to find another fracture weeks later at a level not included on the original MRI. This may even occur at a nearby level when the imaging workup only included plain films …