Retrospective review of biopsy results following percutaneous fixation of vertebral compression fractures.
BACKGROUND
Percutaneous vertebral body fixation has been found to provide pain relief and restoration of function for patients with compression fractures. Despite the prevalence of osteoporosis, there are a variety of aetiologies, such as lymphoma, myeloma or metastatic disease that may be responsible for the condition. In these instances, vertebral body biopsy can play an important role in determining fracture aetiology and assist in initiating concurrent medical treatment.


METHODS
Between 2002 and 2005, 80 vertebral body biopsies were performed in conjunction with percutaneous augmentation procedures on 50 patients at our teaching institution. Eleven biopsies were performed during vertebroplasty and 69 were performed during kyphoplasty. The mean age at the time of procedure was 75.7 years. Eight patients were male and 42 were female. A pathologist interpreted all biopsy samples and all charts were reviewed examining past history, diagnoses prior to compression fracture, biopsy results and post-op conditions that developed or were diagnosed after surgery.


RESULTS
All patients healed their compression fractures following surgery and no complications were experienced. Eleven patients had a diagnosis of osteoporosis prior to vertebral fracture, while 8 patients had a malignant condition initially suspected as being responsible for the compression fracture. Malignancy was identified in 4 patients, 3 of whom did not previously have such a diagnosis. In an additional 6 cases the suspected aetiology behind vertebral compression fracture was not confirmed by pathology.


CONCLUSIONS
This study found a 20% prevalence of malignancy in our population, which is higher than other reports in the literature. Eight percent of the patients in this study were ultimately found to have a malignant aetiology behind their compression fracture, while in 18% of the cases the presumed aetiology was not confirmed on pathological examination. Compression fractures can be one of the most common manifestations of osteoporosis, but a variety of other conditions, including neoplastic processes may also be responsible. As a result, we recommend obtaining a vertebral body biopsy prior to every vertebral augmentation procedure.
Schoenfeld
Andrew J
AJ
Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Akron, OH, United States. ajschoen@neoucom.edu
Dinicola
Nicholas J
NJ
Ehrler
Douglas M
DM
Koerber
Andrea
A
Paxos
Mihail
M
Shorten
Scott D
SD
Bowers
Jacqueline
J
Jackson
Erin
E
Smith
Michael J
MJ
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001843:Bone Cements / Q000627:therapeutic use; D005260:Female; D050815:Fractures, Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000473:pathology; D019904:Polymethyl Methacrylate / Q000627:therapeutic use; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D013125:Spinal Neoplasms / Q000150:complications / Q000473:pathology / Q000556:secondary; D054854:Vertebroplasty / Q000379:methods*
D001843:Bone Cements; D019904:Polymethyl Methacrylate