The value of routinely performing a bone biopsy during percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fractures.
METHODS
A retrospective histologic evaluation of biopsies obtained during percutaneous vertebroplasty (PVP) procedures as treatment for presumed osteoporotic vertebral compression fractures.


OBJECTIVE
To determine the rate of unsuspected malignancy in bone biopsies of patients undergoing PVP for osteoporotic vertebral compression fractures.


BACKGROUND
Most vertebral compression fractures, which result from minimal, or no trauma have osteoporosis as underlying cause. The diagnosis osteoporosis is based on clinical and radiologic findings. Even in patients with proven osteoporosis it is not always the true cause of the fractures. In literature, outcomes of bone-biopsies obtained during vertebroplasty have been described with inconsistent percentages of unexpected malignancy.


METHODS
To determine the rate of unsuspected malignancy, 78 biopsies were obtained from 78 patients (18 male; 60 female; mean age, 73 years). The histologic diagnoses of vertebral body biopsy specimens were analyzed in a retrospective study.


RESULTS
Seventy-one biopsies (91%) obtained from 71 patients, were suitable for histologic evaluation. Seven biopsies (9.0%) could not be interpreted as a result of suboptimal quality biopsy material. The population included 10 patients (13%) with a history of malignancy, in this group no malignancy was found in the bone biopsies. In 3 patients (3.8% of all biopsies) previously undiagnosed malignancies, 2 multiple myeloma stage IIa and 1 chondrosarcoma grade I, were found.


CONCLUSIONS
Obtaining bone biopsies during PVPs does not lead to increased morbidity and can verify the pathologic process underlying the vertebral compression fractures. Since this study showed an unsuspected malignancy rate of 3.8%, we recommend routine obtainment of a vertebral body bone biopsy, preferably using a biopsy needle with a diameter larger than 14 Gauge (>2.1 mm/0.083 inch), during every PVP procedure.
Muijs
Sander Paul Jan
SP
Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Akkermans
Paul A
PA
van Erkel
Arian R
AR
Dijkstra
Sander D
SD
D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods / Q000592:standards; D001707:Biopsy, Needle / Q000379:methods; D015984:Causality; D002813:Chondrosarcoma / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D050815:Fractures, Compression / Q000209:etiology / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000453:epidemiology / Q000473:pathology; D010024:Osteoporosis / Q000150:complications* / Q000473:pathology / Q000601:surgery; D011237:Predictive Value of Tests; D015995:Prevalence; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000209:etiology* / Q000473:pathology* / Q000601:surgery; D013125:Spinal Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000473:pathology*; D013131:Spine / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D054854:Vertebroplasty / Q000379:methods / Q000592:standards