BACKGROUND: Vertebral compression fractures (VCFs) are a common and debilitating consequence of multiple myeloma (MM). Acute VCFs often benefit from percutaneous vertebral augmentation (PVA), indicated by bone marrow edema (BME) on MRI. We present a rare case of a MM patient with several acute VCFs lacking BME on imaging who was successfully treated with PVA.

CASE REPORT: A 49-year-old woman with a history of MM presented with acute mid-back pain. MRI revealed multiple compression fractures without BME, interpreted as chronic. Suspicion was increased based on the presentation and a review of prior imaging confirmed recent fractures. The patient then underwent PVA successfully with significant improvement.

DISCUSSION: MRI is the gold standard method of determining the morphology of VCFs. However, this report demonstrates that MRI may not be accurate in detecting BME in MM patients. Clinicians should make a careful evaluation in determining the candidacy of these patients for PVA in case of contradictory MRI findings.

KEYWORDS: Chronic pain management, case report, multiple myeloma, vertebral augmentation, vertebral compression fractures