Vertebral fractures are not always straightforward to detect. In some cases, a patient may continue to experience significant back pain even when a plain X-ray has not identified a fracture.
Digital Vertebral Assessment (DVA) using DEXA provides another way to assess vertebral height, shape and deformity. DEXA can help identify vertebral fractures and provide an accurate picture of spinal health.
At Bone and Body Blueprint, Digital Vertebral Assessment is available at our Te Awamutu and Pukekohe clinics.
What is a DEXA Digital Vertebral Assessment?
A DEXA Digital Vertebral Assessment examines the vertebrae for changes in height and shape that may indicate a fracture or deformity.
The assessment takes approximately three minutes. Six points are measured on each vertebra to assess changes in vertebral shape, with identified deformities graded using the Genant scale.
The Genant scale is used to grade vertebral fractures from mild to severe and to classify the type of deformity, including:
Wedge fractures.
Compression fractures.
Biconcave fractures.
This provides objective information that can assist with diagnosis and ongoing patient management.
Can vertebral fractures be missed on X-rays?
Plain radiography remains an important diagnostic tool, but vertebral fractures are not always detected on an initial X-ray.
Digital Vertebral Assessment can provide additional information where symptoms persist or further fractures are suspected.
Studies discussed in our video have found DVA to have moderate sensitivity and high specificity for detecting vertebral fractures when compared with spinal radiography.
For some patients, this additional assessment can uncover fractures that were not identified on their original X-rays and change the course of their treatment.
When DVA identifies additional vertebral fractures
We have seen examples of this in patients referred to both our Te Awamutu and Pukekohe clinics:
> Case study: Persistent pain following a T12 fracture
A 77-year-old woman had a fracture at T12 identified on a plain X-ray but continued to experience pain five months later.
A DEXA Digital Vertebral Assessment at our Te Awamutu clinic identified additional fractures at T9 and T11.
The assessment classified:
T9 as a Grade 1 wedge fracture.
T11 as a Grade 2 wedge fracture.
T12 as the Grade 2 wedge fracture originally detected on the X-ray.
Identifying the additional fractures changed the course of her treatment and subsequently improved her pain relief and comfort.
> Case study: Multiple additional fractures identified
A 60-year-old woman had a previous T12 fracture, with new fractures at T8 and T9 identified on plain X-rays.
A Digital Vertebral Assessment at our Pukekohe clinic identified further fractures at T6, T7 and T10.
With a greater number of fractures identified than initially recognised, she was referred for an urgent MRI to assess their extent, followed by orthopaedic review.
These cases demonstrate the value of looking further when symptoms and initial imaging do not provide the full clinical picture.
When can a Digital Vertebral Assessment be useful?
DEXA Digital Vertebral Assessment may be considered when:
A patient has ongoing pain but no fracture has been detected on plain X-ray.
A fracture has been detected on X-ray but pain and discomfort continue.
Additional vertebral fractures are suspected.
There is a history of spinal fractures and further assessment of the spine is required.
The progress of vertebral fractures needs to be assessed over time.
The aim is to provide additional information that can support appropriate treatment and patient management.
Referral requirements for Digital Vertebral Assessment
Digital Vertebral Assessment requires a radiology referral containing the relevant clinical history, written and signed by a doctor.
Where the assessment relates to an approved ACC claim, Digital Vertebral Assessment is covered by ACC and there is no cost to the patient.
If you are a GP, specialist or other health professional and are unsure whether your patient meets the referral criteria, our experienced radiographers are happy to discuss the assessment with you.
Digital Vertebral Assessment in Te Awamutu and Pukekohe
At Bone and Body Blueprint, our DEXA services are provided by qualified and experienced radiographers at our clinics in Te Awamutu and Pukekohe.
Contact Bone and Body Blueprint if you would like more information about Digital Vertebral Assessment, referral criteria or whether DVA may be appropriate for your patient.
