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Shea GKH, Kwan KYH. Management of Metastatic Spinal Disease - A Practical Approach. Global Spine J 2024:21925682231173646. [PMID: 39069670 DOI: 10.1177/21925682231173646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVE This review presents a comprehensive approach to the management of spinal metastases. METHODS N/A. RESULTS The wide spectrum of clinical presentation in spinal metastases necessitates a personalized approach to treatment planning. This includes a comprehensive diagnostic workup, oncological management, palliation of symptoms, and surgical intervention if appropriate. A systematic and multidisciplinary approach allows optimal shared decision making to reach an evidence-informed and value-congruent treatment plan for the patient. We highlight how advances in stereotactic body radiotherapy (SBRT) and separation surgery may be incorporated into clinical management from a spine surgeon's perspective. CONCLUSION This review summarizes the approach and management of spinal metastases, its outcomes and complications.
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Affiliation(s)
- Graham Ka Hon Shea
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
| | - Kenny Yat Hong Kwan
- Department of Orthopaedics and Traumatology, School of Clinical Medicine, The University of Hong Kong, Hong Kong
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2
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Saththianathan M, Mallinson PI, Munk PL, Heran MKS. Percutaneous spine biopsy: reaching those hard-to-reach places. Skeletal Radiol 2023; 52:1803-1814. [PMID: 35840815 DOI: 10.1007/s00256-022-04120-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 02/02/2023]
Abstract
Cancer is a leading cause of death, with the spine being the most common site for skeletal metastasis. The spine is also a site for primary malignancy, such as sarcoma and chordoma, as well as non-neoplastic pathologies. An accurate diagnosis of spinal neoplastic diseases is crucial in determining appropriate management. With the advent of personalised oncology, the need to establish a definitive histopathologic diagnosis to guide management is more important than ever. Percutaneous biopsy has proven to be safe and efficient in establishing a reliable histopathologic diagnosis. The spine, however, can be a challenging site to biopsy, due to the proximity of critical neurovascular, respiratory, and gastrointestinal structures. Successful spine biopsy depends on several factors: suspected diagnosis, size of the lesion, location within the spine, modality for best imaging guidance, operator experience, technical equipment considerations, and desired approach and associated limitations. The specimen must also be obtained with a biopsy route amenable to any future surgical intervention, with surgical input often sought, frequently in a multidisciplinary setting, to confirm procedure-specific goals and expectations. Knowledge of the requisite local anatomy, procedural and patient-specific indications, and contraindications and various approaches that may be used to access different segments of the spine, potential complications, and how to address these are keys to a successful percutaneous spinal biopsy, even in the most challenging of circumstances.
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Affiliation(s)
- Mayuran Saththianathan
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada
| | - Paul Ian Mallinson
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada
| | - Peter Loren Munk
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada
| | - Manraj Kanwal Singh Heran
- Department of Radiology, University of British Columbia, Vancouver General Hospital, 899 W 12th Ave., Vancouver, BC, V5Z 1E9, Canada.
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Maciejczak A, Gasik R, Kotrych D, Rutkowski P, Antoniak K, Derenda M, Dobiecki K, Górski R, Grzelak L, Guzik G, Harat M, Janusz W, Jarmużek P, Łątka D, Maciejczyk A, Mandat T, Potaczek T, Rocławski M, Trembecki Ł, Załuski R. Spinal tumours: recommendations of the Polish Society of Spine Surgery, the Polish Society of Oncology, the Polish Society of Neurosurgeons, the Polish Society of Oncologic Surgery, the Polish Society of Oncologic Radiotherapy, and the Polish Society of Orthopaedics and Traumatology. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1300-1325. [PMID: 36854861 DOI: 10.1007/s00586-023-07546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
PURPOSE The purpose of these recommendations is to spread the available evidence for evaluating and managing spinal tumours among clinicians who encounter such entities. METHODS The recommendations were developed by members of the Development Recommendations Group representing seven stakeholder scientific societies and organizations of specialists involved in various forms of care for patients with spinal tumours in Poland. The recommendations are based on data yielded from systematic reviews of the literature identified through electronic database searches. The strength of the recommendations was graded according to the North American Spine Society's grades of recommendation for summaries or reviews of studies. RESULTS The recommendation group developed 89 level A-C recommendations and a supplementary list of institutions able to manage primary malignant spinal tumours, namely, spinal sarcomas, at the expert level. This list, further called an appendix, helps clinicians who encounter spinal tumours refer patients with suspected spinal sarcoma or chordoma for pathological diagnosis, surgery and radiosurgery. The list constitutes a basis of the network of expertise for the management of primary malignant spinal tumours and should be understood as a communication network of specialists involved in the care of primary spinal malignancies. CONCLUSION The developed recommendations together with the national network of expertise should optimize the management of patients with spinal tumours, especially rare malignancies, and optimize their referral and allocation within the Polish national health service system.
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Affiliation(s)
- A Maciejczak
- Department of Neurosurgery, Szpital Wojewódzki Tarnów, University of Rzeszów, Rzeszów, Poland.
| | - R Gasik
- Department of Neuroorthopedics and Neurology, National Geriatrics, Rheumatology and Rehabilitation Institute, Warsaw, Poland
| | - D Kotrych
- Department of Orthopedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Szczecin, Poland
| | - P Rutkowski
- Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - K Antoniak
- Department of Orthopedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Szczecin, Poland
| | - M Derenda
- Department of Neurosurgery, University of Warmia and Mazury, Olsztyn, Poland
| | - K Dobiecki
- Department of Orthopedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Szczecin, Poland
| | - R Górski
- Department of Neurosurgery and Spine Surgery, John Paul II Western Hospital, Grodzisk Mazowiecki, Poland
| | - L Grzelak
- Department of Neurosurgery, City Hospital, Toruń, Poland
| | - G Guzik
- Department of Oncologic Orthopedics, Sub-Carpathian Oncology Center, Brzozów, Poland
| | - M Harat
- Department of Oncology and Brachytherapy, Oncology Center Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - W Janusz
- Department of Orthopedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - P Jarmużek
- Department of Neurosurgery, University of Zielona Góra, Zielona Góra, Poland
| | - D Łątka
- Department of Neurosurgery, University of Opole, Opole, Poland
| | - A Maciejczyk
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - T Mandat
- Department of Nervous System Neoplasms, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - T Potaczek
- Department of Orthopedics and Rehabilitation, University Hospital Zakopane, Jagiellonian University, Kraków, Poland
| | - M Rocławski
- Department of Orthopaedics, Medical University of Gdansk, Gdańsk, Poland
| | - Ł Trembecki
- Department of Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - R Załuski
- Department of Neurosurgery, Wroclaw Medical University, Wroclaw, Poland
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Marruzzo D, Mancini F, Ricciuti V, Barbieri FR, Preziosi R, Pagano S, Ricciuti RA. Modified percutaneous biopsy of the spine: improvement of the technique. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:221-227. [PMID: 36477894 DOI: 10.1007/s00586-022-07384-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 09/04/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE Biopsy of the spine can be performed by open surgery or percutaneous needle sampling. The first has the highest diagnostic yield while the second is a less invasive procedure with lower rate of complications and shorter hospitalization time. We described a modified technique of percutaneous biopsy using semi-rigid grasping forceps that may offer the advantages of both, open and minimally invasive surgery. METHODS Thirty consecutive patients with spinal lesions requiring biopsy were admitted to Neurosurgical Unit of Belcolle Hospital (Viterbo, Italy) from January 2017 to September 2021. There was a suspicion of spondylodiscitis in 25 cases and of tumor in 5 cases. Percutanous trans-pedicular spine biopsy has been performed using this new semi-rigid grasping forceps. Combining the opening width, jaw length and full 360° rotation, the device allows a wide and precise sampling. RESULTS Sampling was sufficient in all cases (100%); tumors was observed in 5 cases (16.7%%) with a percentage of definitive histopathologic diagnosis of 100% (n = 5); among the remaining patients histological examination yielded a diagnosis of spinal infection in 25 cases (100%), and microbiologic culture provided an aetiologic diagnosis in 23 cases (92%). All procedures were well tolerated, and no postoperative complications were observed. Levels involved included: thoracic (T5-T9) in 8 cases, thoracolumbar junction (T10-L2) in 12 cases and lumbar (L3-L5) in 10 cases. CONCLUSIONS Percutaneous biopsy with the semi-rigid grasping forceps is a safe and effective procedure that can be used for diagnosis of both infectious and tumor lesions of the spine. It allows to obtain a larger specimen volume and to use a multidirectional trajectory for sampling, resulting in a minimally invasive technique with strong ability to yield etiologic diagnosis.
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Shao X, Li J, Yang Q, Li K, Yao Y, Sun F, Li Z. Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme, Biopsy Procedure, Core Technique Analysis, Diagnostic Yield and Clinical Outcome. Orthop Surg 2022; 14:1593-1606. [PMID: 35706342 PMCID: PMC9363750 DOI: 10.1111/os.13366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 05/22/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy. METHODS A series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including "lesion perforating", "aspiration", "cutting-and-scraping" and "biopsy forceps utilization" were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case. RESULTS Eight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow-up period (1-39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores. CONCLUSION With a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well-tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.
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Affiliation(s)
- Xianhao Shao
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jianmin Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qiang Yang
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ka Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yuan Yao
- Department of Radiography, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Feifei Sun
- Department of Pathology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhenfeng Li
- Department of Orthopaedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Zhou F, Niu N, Liang Q, Chang Y, Shi J, Wang Z. Clinical application of a modified percutaneous vertebroplasty instrument in vertebral body biopsy in adults. BMC Musculoskelet Disord 2022; 23:163. [PMID: 35183155 PMCID: PMC8857814 DOI: 10.1186/s12891-022-05117-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 02/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Percutaneous vertebroplasty (PVP) has been widely used to treat vertebral pathological fractures in recent decades, and the modified PVP instrument is very suitable for percutaneous biopsy of diseases promoting vertebral bone destruction. The purpose of this study was to evaluate the relevance of the clinical application of the modified PVP instrument in computed tomography-guided (CT-guided) biopsies of the vertebral body. Methods Retrospective analysis of clinical data obtained by percutaneous biopsy using a modified PVP outer shell of a bone filler device (OSBF) from 161 patients presenting vertebral body destruction was conducted. The rate of correctly performed biopsy diagnosis was evaluated from three aspects: imaging performance, histological type, and vertebral segment. Results The results of 149 biopsy cases were consistent with the final clinical diagnosis. From those cases, 92 were diagnosed as vertebral body metastasis, 45 cases presented primary spinal tumors and tumor-like changes, 7 cases presented vertebral body infections, and 5 cases displayed normal bones or fractures. From the remaining 12 patients, whose biopsy results were inconsistent with the final clinical diagnosis, 4 presented vertebral metastases, 4 displayed primary vertebral tumors, and 4 presented vertebral infections. The diagnostic rate of the modified PVP OSBF biopsy was 92.5%. The rate of correct biopsy diagnosis for vertebral metastases was 95.8%. The rate of correct diagnosis of primary vertebral tumors and tumor-like biopsy was 91.8%, and the rate of correct diagnosis for vertebral infectious diseases was 63.6%. Conclusion The modified PVP OSBF allows obtaining more lesion tissue, in multiple directions and multiple angles, during the biopsy of vertebral bones presenting destructive lesions. The technique displays appropriate safety and high diagnostic accuracy and presents a desirable reference value for the preoperative diagnosis of diseases that yield vertebral bone destruction, especially for vertebral tumor lesions.
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Abstract
Even in pandemic times cancer remains one of the leading causes of death worldwide. Spine and peripheral skeleton constitute a common location for metastatic disease whilst numerous sarcomatous and other primary cancers may be depicted in the musculoskeletal system. Tissue sampling is necessary for histopathological identification as well as for molecular profiling in order to personalize cancer prevention, diagnosis and treatment; in addition cultures of bone and soft tissue sampling contribute to identifying pathogens in order to provide the most appropriate systemic therapy. Performing an open surgical biopsy increases morbidity and mortality while at the same time runs the risk of destabilizing a pathologic segment. Imaging guidance ensures high safety and efficacy rates and contributes to the minimally invasive character of percutaneous biopsy by providing immediate confirmation of correct needle location in the area of interest. Selecting the imaging guidance method which will visualize the target lesion and the needle trajectory as well as the largest possible needle biopsy that can maximize the diagnostic yield is of outmost importance for high safety and efficacy rates. The purpose of the present review is to provide a comprehensive, current overview of percutaneous, imaging guided biopsy in the spine and peripheral skeleton, to become familiar with the most common indications, to learn about different technical considerations during performance and to provide the current evidence. Controversies concerning products will be addressed.
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Geijer M, Inci F, Solidakis N, Szaro P, Al-Amiry B. The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica. Acta Radiol 2021; 62:1460-1472. [PMID: 34664508 PMCID: PMC8647486 DOI: 10.1177/02841851211050866] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 11/23/2022]
Abstract
During the last 100 years, musculoskeletal radiology has developed from bone-only radiography performed by everyone to a dedicated subspecialty, still secure in its origins in radiography but having expanded into all modalities of imaging. Like other subspecialties in radiology, it has become heavily dependent on cross-sectional and functional imaging, and musculoskeletal interventions play an important role in tumor diagnosis and treatment and in joint diseases. All these developments are reflected in the pages in Acta Radiologica, as shown in this review.
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Affiliation(s)
- Mats Geijer
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, 70712University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Fatih Inci
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nektarios Solidakis
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, 70712University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, 56749Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bariq Al-Amiry
- Department of Clinical Science, Intervention and Technology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
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Singh DK, Boruah T, Sharma A, Khanna G, Krishna LG, Kumar N. Comparative analysis of CT guided vertebral biopsy by a conventional bone biopsy needle versus bone biopsy needle with acquisition cradle. J Clin Orthop Trauma 2021; 19:231-236. [PMID: 34150496 PMCID: PMC8193153 DOI: 10.1016/j.jcot.2021.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We aimed to compare the rate of diagnostically successful vertebral biopsies using conventional bone biopsy needles versus those performed with bone biopsy needles with an acquisition cradle. METHODS We retrospectively analyzed the data of patients who underwent CT-guided vertebral biopsy between December 2017 to December 2019 at our institute. From December 2017 to November 2018, the procedure was performed on 185 patients using an 11G conventional bone biopsy needle, Jamshidi needleTM "(group 1)". From December 2018 to December 2019, the procedure was performed on 242 patients using an 11G T-handle Jamshidi needle with an acquisition cradle "(group 2)". We reviewed their histopathological reports for both groups of patients to determine the rate of diagnostically successful biopsies. We also compared the crush artifact amongst the unsuccessful biopsy samples acquired by the two types of biopsy needles. RESULTS 427 patients (270 male and 157 female patients; mean age, 46.4 years; age range, 25-67 years) who underwent CT-guided vertebral biopsy from December 2017 to December 2019 were included in our study. In group 1, diagnostic success was achieved in 136 out of 185 biopsies (73.5%); whereas in group 2, diagnostic success was achieved in 219 out of 242 biopsies (90.50%), p < 0.0001. Out of the diagnostically unsuccessful biopsies in Group 1, 36 out of 49 (73.5%) were due to crush artifact; whereas crush artifact accounted for only 3 out of 23 (13.0%) diagnostically unsuccessful biopsies in group 2, p < 0.0001. Other causes of unsuccessful biopsies (hemorrhagic contents or presence of normal osseous tissue and fibrin only) were statistically insignificant. CONCLUSION The use of a T-handle Jamshidi needle with an acquisition cradle appears beneficial compared to the conventional Jamshidi needle in terms of the significantly higher rate of diagnostic success and a lower rate of crush artifact.
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Affiliation(s)
- Dharmendra Kumar Singh
- Department of Radiodiagnosis, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Tankeshwar Boruah
- Central Institute of Orthopedics, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Anuradha Sharma
- Department of Radiodiagnosis, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Geetika Khanna
- Central Institute of Orthopedics, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Loveneesh G. Krishna
- Central Institute of Orthopedics, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India
| | - Nishith Kumar
- Department of Radiodiagnosis, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India,Corresponding author. Department of Radiodiagnosis, Vardhmaan Mahavir Medical College and Safdarjung Hospital, New Delhi, 110029, India.
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Review article: the current status of CT-guided needle biopsy of the spine. Skeletal Radiol 2021; 50:281-299. [PMID: 32815040 DOI: 10.1007/s00256-020-03584-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
CT-guided percutaneous needle biopsy of the spine is a well-described technique for determining the nature of indeterminate vertebral lesions or establishing a diagnosis of spinal infection, the high diagnostic accuracy and the safety of the procedure having been extensively documented. The purpose of the current article is to review the literature to date on CT-guided spinal biopsy. Specifically, indications for spinal biopsy, techniques for optimising yield, detail of the approaches for various spinal levels which is dependent upon both the region within the spinal column and lesion location within the vertebra (body vs. neural arch), determinants of biopsy outcome and complications are covered. It is hoped that the review will be of particular benefit to junior radiologists who are required to perform this procedure.
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Kumar V, Beniwal R, Kundu Z, Kundu A, Naqvi M, Arora K, Sihag R. Efficacy of computed tomography-guided biopsy in vertebral lesions: A prospective study. JOURNAL OF ORTHOPAEDIC DISEASES AND TRAUMATOLOGY 2021. [DOI: 10.4103/jodp.jodp_12_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Aithala JP, Attar A, Imthiaz AKA, Rai M. Is there a change in trend towards pyogenous spondylodiscitis compared to tubercular spondylodiscitis in India-A study of percutaneous biopsy evaluation in spondylodiscitis. Indian J Tuberc 2020; 67:509-514. [PMID: 33077052 DOI: 10.1016/j.ijtb.2020.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In Indian subcontinent where tuberculosis is endemic, the spinal infection was thought to be due to mycobacterium tuberculosis in most of the cases. Hence there is a practice of treating these patients with empirical antitubercular treatment. However, recent guidelines advice biopsy and tissue diagnosis before starting antibiotics. OBJECTIVE OF STUDY Our retrospective study analyses the role of biopsy in establishing the microbiological diagnosis and thus identifying the incidence of pyogenic and tubercular spondylodiscitis presented to a tertiary care centre. MATERIALS AND METHODS All patients who were diagnosed as spondylodiscitis by clinical and radiological criteria and who underwent biopsy were included in the study and data was retrieved from medical records and PACS. Criteria for tubercular spondylodiscitis included presence of mycobacterium tuberculosis either in smear/gene Xpert, or histopathological evidence of tuberculosis. Organism isolation other than MTB or absence of tubercular granuloma and response to antibiotics were considered as non-tubercular aetiology. RESULTS Our study achieved 84% (n-63) accuracy for first biopsy and 34 patients (53.96%) were diagnosed as pyogenic spondylodiscitis. Organisms were isolated in 11 cases (32%) of pyogenic spondylodiscitis and tubercular bacilli in 17 cases (65%) of tubercular spondylodiscitis. Aspiration of pus yielded better isolation of organisms (P < 0.001) in pyogenic spondylodiscitis. 11% of cases showed drug resistant tuberculosis. CONCLUSION We conclude that there is an increasing trend of pyogenous spondylodiscitis compared to tubercular spondylodiscitis in patients presenting to tertiary care centre, hence biopsy is essential to start antimicrobials.
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Affiliation(s)
- Janardhana P Aithala
- Department of Orthopedics, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Arshad Attar
- Department of Orthopedics, Kanachur Medical College, Mangalore, Karnataka, India.
| | - Ahammed K A Imthiaz
- Department of Orthopedics, Yenepoya Medical College, Mangalore, Karnataka, India
| | - Mahabala Rai
- Department of Orthopedics, Yenepoya Medical College, Mangalore, Karnataka, India
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Abstract
In July of 2018, the Second International Consensus Meeting (ICM) on Musculoskeletal Infection convened in Philadelphia, PA was held to discuss issues regarding infection in orthopedic patients and to provide consensus recommendations on these issues to practicing orthopedic surgeons. During this meeting, attending delegates divided into subspecialty groups to discuss topics specifics to their respective fields, which included the spine. At the spine subspecialty group meeting, delegates discussed and voted upon the recommendations for 63 questions regarding the prevention, diagnosis, and treatment of infection in spinal surgery. Of the 63 questions, 17 focused on the use of antibiotics in spine surgery, for which this article provides the recommendations, voting results, and rationales.
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Abstract
Fine-needle aspiration (FNA) and core needle biopsy are the primary diagnostic modalities for assessing mass lesions. Any superficial or deep-seated lesion occurring anywhere in the body, including bone and soft tissue, can undergo this procedure to pathologically characterize it. The outcomes of FNA, performed either alone or in combination with core biopsy, are best when performed and interpreted by skilled individuals. The roles of interventional radiologists and cytologists are pivotal in ensuring adequacy of the specimen and leading the clinical team in making the diagnosis and avoiding repeat diagnostic procedures or a more invasive open surgical biopsy.
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Affiliation(s)
- Israh Akhtar
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
| | - Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
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Filippiadis D, Mazioti A, Kelekis A. Percutaneous, Imaging-Guided Biopsy of Bone Metastases. Diagnostics (Basel) 2018; 8:diagnostics8020025. [PMID: 29670012 PMCID: PMC6023375 DOI: 10.3390/diagnostics8020025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/10/2018] [Accepted: 04/16/2018] [Indexed: 12/15/2022] Open
Abstract
Approximately 70% of cancer patients will eventually develop bone metastases. Spine, due to the abundance of red marrow in the vertebral bodies and the communication of deep thoracic-pelvic veins with valve-less vertebral venous plexuses, is the most common site of osseous metastatic disease. Open biopsies run the risk of destabilizing an already diseased spinal or peripheral skeleton segment. Percutaneous biopsies obviate such issues and provide immediate confirmation of correct needle location in the area of interest. Indications for percutaneous bone biopsy include lesion characterization, optimal treatment and tumor recurrence identification, as well as tumor response and recurrence rate prediction. Predicting recurrence in curative cases could help in treatment stratification, identification, and validation of new targets. The overall accuracy of percutaneous biopsy is 90–95%; higher positive recovery rates govern biopsy of osteolytic lesions. The rate of complications for percutaneous biopsy approaches is <5%. The purpose of this review is to provide information about performing bone biopsy and what to expect from it as well as choosing the appropriate imaging guidance. Additionally, factors governing the appropriate needle trajectory that would likely give the greatest diagnostic yield and choice of the most appropriate biopsy system and type of anesthesia will be addressed.
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Affiliation(s)
- Dimitrios Filippiadis
- 2nd Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
| | - Argyro Mazioti
- 2nd Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
| | - Alexios Kelekis
- 2nd Radiology Department, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece.
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16
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Sperandeo M, Trovato FM, Melillo N, Dimitri L, Musumeci G, Guglielmi G. The role of ultrasound-guided fine needle aspiration biopsy in musculoskeletal diseases. Eur J Radiol 2017; 90:234-244. [PMID: 28583640 DOI: 10.1016/j.ejrad.2017.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 02/22/2017] [Accepted: 02/27/2017] [Indexed: 12/13/2022]
Abstract
Ultrasonography (US) is a readily available non-invasive tool useful for the detection of musculoskeletal and soft tissue masses. Although X-Ray is often the first imaging study for evaluating both bone and soft tissue lesions, and magnetic resonance imaging and computed tomography are mandatory in lesions staging, US is increasingly used for the early assessment of musculoskeletal and soft-tissue masses and for guiding procedures and biopsies. Surgical biopsy or fine needle aspiration biopsy (FNAB) is needed to ascertain the nature of any lesion. FNAB is a low cost technique, safer and less traumatic than an open surgical biopsy. Significant complications are rare, mostly related to the site of biopsy. Knowledge of indications, limitations, anatomical and pathological access, adequate technical expertise in US imaging and in intervention skills are the critical factors of the appropriate and safe use of FNAB. By now, the role of FNAB in musculoskeletal diseases is controversial and there is still a heated debate in the scientific community.
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Affiliation(s)
- Marco Sperandeo
- Unit of Intervenional Ultrasound of Internal Medicine, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy
| | - Francesca Maria Trovato
- Department of Clinical and Experimental Medicine, Internal Medicine Division, School of Medicine, University of Catania, Italy
| | - Nadia Melillo
- Rheumatology Unit, Department of Medical Science, University of Foggia, Italy
| | - Lucia Dimitri
- Histology and Pathology Unit, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Italy
| | - Giuseppe Guglielmi
- Department of Radiology, University of Foggia, Viale Luigi Pinto 1, Foggia, Italy; Department of Radiology, Scientific Institute Hospital "Casa Sollievo della Sofferenza", Viale Cappuccini 1, San Giovanni Rotondo, FG, Italy.
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Harmon SA, Tuite MJ, Jeraj R. Molecular image-directed biopsies: improving clinical biopsy selection in patients with multiple tumors. Phys Med Biol 2016; 61:7282-7299. [PMID: 27694707 DOI: 10.1088/0031-9155/61/20/7282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Site selection for image-guided biopsies in patients with multiple lesions is typically based on clinical feasibility and physician preference. This study outlines the development of a selection algorithm that, in addition to clinical requirements, incorporates quantitative imaging data for automatic identification of candidate lesions for biopsy. The algorithm is designed to rank potential targets by maximizing a lesion-specific score, incorporating various criteria separated into two categories: (1) physician-feasibility category including physician-preferred lesion location and absolute volume scores, and (2) imaging-based category including various modality and application-specific metrics. This platform was benchmarked in two clinical scenarios, a pre-treatment setting and response-based setting using imaging from metastatic prostate cancer patients with high disease burden (multiple lesions) undergoing conventional treatment and receiving whole-body [18F]NaF PET/CT scans pre- and mid-treatment. Targeting of metastatic lesions was robust to different weighting ratios and candidacy for biopsy was physician confirmed. Lesion ranked as top targets for biopsy remained so for all patients in pre-treatment and post-treatment biopsy selection after sensitivity testing was completed for physician-biased or imaging-biased scenarios. After identifying candidates, biopsy feasibility was evaluated by a physician and confirmed for 90% (32/36) of high-ranking lesions, of which all top choices were confirmed. The remaining cases represented lesions with high anatomical difficulty for targeting, such as proximity to sciatic nerve. This newly developed selection method was successfully used to quantitatively identify candidate lesions for biopsies in patients with multiple lesions. In a prospective study, we were able to successfully plan, develop, and implement this technique for the selection of a pre-treatment biopsy location.
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Affiliation(s)
- Stephanie A Harmon
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, 7033 Wisconsin Institutes for Medical Research, 1111 Highland Avenue, Madison, WI 53705, USA
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18
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Garg V, Kosmas C, Josan ES, Partovi S, Bhojwani N, Fergus N, Young PC, Robbin MR. Computed tomography–guided percutaneous biopsy for vertebral neoplasms: a department's experience and hybrid biopsy technique to improve yield. Neurosurg Focus 2016; 41:E17. [DOI: 10.3171/2016.4.focus1614] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
Recent articles have identified the poor diagnostic yield of percutaneous needle biopsy for vertebral osteomyelitis. The current study aimed to confirm the higher accuracy of CT-guided spinal biopsy for vertebral neoplasms and to identify which biopsy technique provides the highest yield.
METHODS
Over a 9-year period, the radiology department at University Hospitals Case Medical Center performed 222 CT-guided biopsies of vertebral lesions, of which clinicians indicated a concern for vertebral neoplasms in 122 patients. A retrospective chart review was performed to confirm the higher sensitivity of the percutaneous intervention for vertebral neoplasms.
RESULTS
A core sample was obtained for all 122 biopsies of concern (100.0%). Only 6 cases (4.9%) were reported as nondiagnostic per histological sampling, and 12 cases (9.8%) were negative for disease. The question of vertebral neoplastic involvement warrants follow-up, and the current study was able to determine the subsequent diagnosis of each lesion. Of the 122 total, 94 (77.0%) core samples provided true-positive results, and the sensitivity of core biopsy measured 87.9%. The technical approach did not demonstrate any significant difference in diagnostic yield. However, when the vertebral cortex was initially pierced with a coaxial bone biopsy system and subsequently a 14-gauge spring-loaded cutting biopsy needle was coaxially advanced into lytic lesions, 14 true positives were obtained with a corresponding sensitivity of 100.0%.
CONCLUSIONS
This study confirms the higher sensitivity of image-guided percutaneous needle biopsy for vertebral neoplasms. In addition, it demonstrates how the use of a novel cutting needle biopsy approach, performed coaxially through a core biopsy track, provides the highest yield.
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Affiliation(s)
- Vasant Garg
- 1Department of Radiology, University Hospitals Case Medical Center, and
| | - Christos Kosmas
- 1Department of Radiology, University Hospitals Case Medical Center, and
| | - Enambir S. Josan
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sasan Partovi
- 1Department of Radiology, University Hospitals Case Medical Center, and
| | - Nicholas Bhojwani
- 1Department of Radiology, University Hospitals Case Medical Center, and
| | - Nathan Fergus
- 1Department of Radiology, University Hospitals Case Medical Center, and
| | - Peter C. Young
- 1Department of Radiology, University Hospitals Case Medical Center, and
| | - Mark R. Robbin
- 1Department of Radiology, University Hospitals Case Medical Center, and
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Shibata H, Kato S, Sekine I, Abe K, Araki N, Iguchi H, Izumi T, Inaba Y, Osaka I, Kato S, Kawai A, Kinuya S, Kodaira M, Kobayashi E, Kobayashi T, Sato J, Shinohara N, Takahashi S, Takamatsu Y, Takayama K, Takayama K, Tateishi U, Nagakura H, Hosaka M, Morioka H, Moriya T, Yuasa T, Yurikusa T, Yomiya K, Yoshida M. Diagnosis and treatment of bone metastasis: comprehensive guideline of the Japanese Society of Medical Oncology, Japanese Orthopedic Association, Japanese Urological Association, and Japanese Society for Radiation Oncology. ESMO Open 2016; 1:e000037. [PMID: 27843593 PMCID: PMC5070259 DOI: 10.1136/esmoopen-2016-000037] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 02/02/2016] [Indexed: 01/14/2023] Open
Abstract
Diagnosis and treatment of bone metastasis requires various types of measures, specialists and caregivers. To provide better diagnosis and treatment, a multidisciplinary team approach is required. The members of this multidisciplinary team include doctors of primary cancers, radiologists, pathologists, orthopaedists, radiotherapists, clinical oncologists, palliative caregivers, rehabilitation doctors, dentists, nurses, pharmacists, physical therapists, occupational therapists, medical social workers, etc. Medical evidence was extracted from published articles describing meta-analyses or randomised controlled trials concerning patients with bone metastases mainly from 2003 to 2013, and a guideline was developed according to the Medical Information Network Distribution Service Handbook for Clinical Practice Guideline Development 2014. Multidisciplinary team meetings are helpful in diagnosis and treatment. Clinical benefits such as physical or psychological palliation obtained using the multidisciplinary team approaches are apparent. We established a guideline describing each specialty field, to improve understanding of the different fields among the specialists, who can further provide appropriate treatment, and to improve patients’ outcomes.
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Affiliation(s)
- H Shibata
- Department of Clinical Oncology , Akita University Graduate School of Medicine , Akita , Japan
| | - S Kato
- Department of Clinical Oncology , Juntendo University , Tokyo , Japan
| | - I Sekine
- Department of Clinical Oncology , University of Tsukuba , Tsukuba , Japan
| | - K Abe
- Department of Rehabilitation , Chiba Prefectural University of Health Sciences , Chiba , Japan
| | - N Araki
- Department of Orthopedic Surgery , Osaka Medical Center for Cancer and Cardiovascular Diseases , Osaka , Japan
| | - H Iguchi
- Department of Gastroenterology , National Hospital Organization Shikoku Cancer Center , Matsuyama , Japan
| | - T Izumi
- Division of Hematology , Tochigi Cancer Center , Utsunomiya , Japan
| | - Y Inaba
- Department of Diagnostic and Interventional Radiology , Aichi Cancer Center Hospital , Nagoya , Japan
| | - I Osaka
- Division of Palliative Medicine , Shizuoka Cancer Center , Sunto-gun , Japan
| | - S Kato
- Department for Cancer Chemotherapy , Iwate Prefectural Central Hospital , Morioka , Japan
| | - A Kawai
- Division of Musculoskeletal Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - S Kinuya
- Department of Nuclear Medicine , Kanazawa University Hospital , Kanazawa , Japan
| | - M Kodaira
- Department of Breast and Medical Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - E Kobayashi
- Division of Musculoskeletal Oncology , National Cancer Center Hospital , Tokyo , Japan
| | - T Kobayashi
- Department of Diagnostic and Interventional Radiology , Ishikawa Prefectural Central Hospital , Kanazawa , Japan
| | - J Sato
- Department of Clinical Pharmaceutics , School of Pharmacy, Iwate Medical University , Morioka , Japan
| | - N Shinohara
- Department of Renal and Genitourinary Surgery , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - S Takahashi
- Department of Medical Oncology , Cancer Institute Hospital of Japanese Foundation for Cancer Research , Tokyo , Japan
| | - Y Takamatsu
- Division of Medical Oncology , Hematology and Infectious Diseases, Fukuoka University Hospital , Fukuoka , Japan
| | - K Takayama
- Seirei Christopher University , Hamamatsu , Japan
| | - K Takayama
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University , Fukuoka , Japan
| | - U Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine , Tokyo Medical and Dental University , Tokyo , Japan
| | - H Nagakura
- Department of Radiology , KKR Sapporo Medical Center , Sapporo , Japan
| | - M Hosaka
- Department of Orthopaedic Surgery , Tohoku University Graduate School of Medicine , Sendai , Japan
| | - H Morioka
- Department of Orthopaedic Surgery , Keio University School of Medicine , Tokyo , Japan
| | - T Moriya
- Department of Pathology 2 , Kawasaki Medical School , Kurashiki , Japan
| | - T Yuasa
- Department of Urology , Cancer Institute Hospital, Japanese Foundation for Cancer Research , Tokyo , Japan
| | - T Yurikusa
- Division of Dentistry and Oral Surgery , Shizuoka Cancer Center , Sunto-gun , Japan
| | - K Yomiya
- Department of Palliative Care , Saitama Cancer Center , Kitaadachi-gun , Japan
| | - M Yoshida
- Department of Hemodialysis and Surgery , Chemotherapy Research Institute, International University of Health and Welfare , Ichikawa , Japan
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20
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Abstract
Spinal infections are challenging to diagnose and represent a life-threatening medical condition. Diagnosis is often delayed because of nonspecific accompanying symptoms. The role of interventional neuroradiology in spinal infection is double: diagnostic and therapeutic, consisting substantially of 2 main procedures, represented by spine biopsies and positioning of percutaneous drainage, which represent a minimally invasive, faster and more cost-effective alternative to open surgery procedures. This article will focus on the available state-of-the-art techniques to perform discovertebral image-guided biopsies in case of suspected infections and on image-guided placement of percutaneous drainage to treat infectious collections of the spine and paravertebral structures.
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Affiliation(s)
- Prof Massimo Gallucci
- Neuroradiology Unit, S. Salvatore Hospital, University of L'Aquila, Via L. Natali, L'Aquila 67100, Italy.
| | - Federico D'Orazio
- Neuroradiology Unit, S. Salvatore Hospital, Via L. Natali, L'Aquila 67100, Italy
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Susceptibility Pattern of Microorganisms Isolated by Percutaneous Needle Biopsy in Nonbacteremic Pyogenic Vertebral Osteomyelitis. Antimicrob Agents Chemother 2015; 59:7700-6. [PMID: 26438497 DOI: 10.1128/aac.01516-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/23/2015] [Indexed: 11/20/2022] Open
Abstract
Pyogenic vertebral osteomyelitis (VO) is diagnosed according to several lines of evidence: clinical, biological, radiological, and histological. Definitive diagnosis requires the isolation of a causative pathogen or histological confirmation. The aim of our study was to describe the microorganisms isolated by percutaneous needle biopsy (PNB) and to analyze their susceptibility patterns, in order to assess the possibility of empirical combination therapy for the treatment of nonbacteremic patients without resorting to PNB. Based on a French prospective multicenter study of 351 patients with VO, we compiled clinical, biological, and radiological findings for 101 patients with microbiologically confirmed VO. Based on antibiotic susceptibility testing of PNB isolated pathogens, the suitabilities of four antibiotic combinations were analyzed: ofloxacin plus rifampin, levofloxacin plus rifampin, ciprofloxacin plus clindamycin, and ciprofloxacin plus amoxicillin-clavulanate. The main causative pathogens identified were coagulase-negative Staphylococcus spp. (26% of isolates), followed by Staphylococcus aureus (21%), Streptoccocus spp. (13%), and enterobacteria (21%). Empirical antibiotic combination therapy was effective in nearly 75% of cases, and the different combinations gave similar results, except for ofloxacin-rifampin, which was effective in only 58% of cases. A "perfect" empirical antibiotic therapy does not exist. If PNB is not possible, a combination of a fluoroquinolone with clindamycin or rifampin can be used, but the high risk of microbiological failure does not allow the exclusion of PNB. (This study has been registered with EudraCT, number 2006-000951-18, and ClinicalTrials.gov, number NCT00764114.).
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Garg V, Kosmas C, Young PC, Togaru UK, Robbin MR. Computed tomography-guided percutaneous biopsy for vertebral osteomyelitis: a department's experience. Neurosurg Focus 2015; 37:E10. [PMID: 25081959 DOI: 10.3171/2014.6.focus14134] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Vertebral osteomyelitis has been reported to occur in approximately 0.2-2 cases per 100,000 annually. Elevated laboratory values such as erythrocyte sedimentation rate and C-reactive protein suggest inflammatory etiologies. Different imaging modalities, from radiography and CT scanning to nuclear medicine imaging and contrastenhanced MRI, can be employed to evaluate for osteomyelitis. Although MRI has a strong sensitivity and specificity for vertebral osteomyelitis, obtaining histological and microbiological samples remains the gold standard in diagnosis. Therapy can be geared toward the specific pathogen cultured, thereby preventing the need surgical intervention in the majority of cases. However, recent reports have questioned the percentage yield of image-guided percutaneous biopsy even when there is a high clinical suspicion for vertebral osteomyelitis. METHODS After obtaining institutional review board approval, the authors performed a chart review of patients who had undergone image-guided percutaneous bone biopsies at University Hospitals Case Medical Center in Cleveland, Ohio. Data were filtered for patients in whom a biopsy sample of a vertebral body/disc was obtained. A total of 213 procedures were performed, of which clinicians indicated a concern for infection in 84, infection or neoplasm in 13, and a noninfectious etiology (the majority being neoplasms) in the remaining 116. RESULTS Histological examination provided positive results in 25 (41.0%) of the 61 samples collected for suspected cases of osteomyelitis. Microbiology samples were less predictive, with only 16 of the 84 samples collected, or 19.0%, yielding a positive result. In 10 patients there were positive blood and/or urine cultures. Of these, 8 samples (80%) demonstrated the same pathogen identified by biopsy (for the remaining 2 positive systemic cultures, no pathogen was identified by the percutaneous intervention). In other words, half of the 16 cases that provided microbiological results from biopsy demonstrated the same results by systemic cultures. However, 89 (76.7%) of the 116 samples collected with the primary concern of neoplasm yielded results. CONCLUSIONS Image-guided percutaneous biopsy for vertebral osteomyelitis demonstrates an extremely low probability of identifying specific microbes. Blood or urine cultures concurrently identified culprit pathogens in 50% of positive biopsy cultures. Therefore, in only 8 (9.5%) of 84 biopsies did the biopsy results provide additional information to clinicians as to the pathological microorganism present and how treatment might need to be adjusted.
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Affiliation(s)
- Vasant Garg
- Department of Radiology, University Hospital Case Medical Center, Cleveland, Ohio
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Sciacca S, Barkas K, Heptinstall L, McNamara C, Shetty R. Rosai-Dorfman disease with spinal cord compression: a diagnostic challenge. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24 Suppl 4:S529-35. [PMID: 25398443 DOI: 10.1007/s00586-014-3671-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/03/2014] [Accepted: 11/03/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE Rosai-Dorfman disease (RDD) is an uncommon benign histiocytic proliferative disorder commonly involving the cervical lymph nodes and less frequently extranodal sites, including, rarely, the central nervous system, mainly intracranially. Spinal involvement is unusual. RDD is characterized by pathognomonic histopathological features, which are decisive in the definitive diagnosis. We present the case of a 75-year-old lady who presented with an isolated thoracic vertebral lesion. She underwent 3 CT-guided biopsies, all not confirmative for a definite diagnosis, and 2 open biopsies and debulking of the lesion. METHODS The clinical notes, operation notes, investigations and clinic letters of the patient were reviewed. A literature search was performed using PubMed, with the keywords "Rosai-Dorfman disease", "sinus histiocytosis with massive lymphadenopathy", "histiocytic proliferative disorder". RESULTS Only the histopathology after the last procedure was diagnostic for Rosai-Dorfman disease. The patient was treated with steroids with marked improvement in her clinical condition. CONCLUSIONS This case demonstrates the challenge in making a diagnosis. RDD should be considered as a differential diagnosis in case of spinal lesion and non-diagnostic biopsy, especially in steroid sensitive lesions. The implications of the case are discussed.
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Affiliation(s)
- Sara Sciacca
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, UK,
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Abstract
OBJECTIVES The objective of the authors was to provide an up-to-date review about the epidemiology, diagnosis, and surgical management of the malignant primary sacral tumors. METHODS A PubMed search was conducted using a combination of the following items: (('Spinal Neoplasms'[Mesh]) AND 'Sacrum'[Mesh]) NOT ('Metastasis' OR 'Metastases' OR 'Benign'). The literature review and the author's own surgical experiences were used to assess the current treatment strategies of the malignant sacral tumors. RESULTS Twenty case series were identified, which studies discuss in detail the surgical strategies, the postoperative complications, the functional and oncologic outcome, and the recurrence-free and disease-specific survival of this rare patient category. DISCUSSION Sacral tumors are rare pathologies. Their management generates a complex medical problem, as they usually are diagnosed in advanced stages with extended dimensions involving the sacral nerves and surrounding organs. The evaluation and complex treatment of these rare tumors require a multidisciplinary approach, optimally at institutions with comprehensive care and experience. Although conventional oncologic therapeutic methods should be used as neoadjuvant or adjuvant therapies in certain histological types, en bloc resection with wide surgical margins is essential for long-term local oncologic control. This is often technically difficult to achieve, as just a few centers in the world perform sacral tumor surgeries on a regular basis, and have enough wide experience. Therefore international cooperation and organization of multicenter tumor registries are essential to develop evidence based treatment protocols.
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Intraoperative Life Threatening Acute Lung Injury Due to Multiple Septic Pulmonary Emboli during Transpedicular Biopsy and Kyphoplasty. Asian Spine J 2014; 8:197-201. [PMID: 24761203 PMCID: PMC3996345 DOI: 10.4184/asj.2014.8.2.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 04/23/2013] [Accepted: 05/01/2013] [Indexed: 11/23/2022] Open
Abstract
A 55-year-old gentleman was presented to our clinic two months after a trivial fall with persistent pain, gibbus at the thoraco-lumbar junction and intact neurology. Radiological and laboratory investigations suggested osteoporotic fracture or metastasis. Due to unremitting pain, a plan was made to do transpedicular biopsy and kyphoplasty. Biopsy needles were inserted into both pedicles and an attempt at aspiration was made. Since the aspirate was dry, 5 to 6 mL of saline was injected through one needle and an attempt at aspiration was made through the other. Three-millilitres of sero-sanguineous material mixed with pus came out and kyphoplasty was deferred. After extubation, the patient developed severe bronchospasm and was transferred to the intensive care unit. Investigations confirmed multiple septic pulmonary emboli and the patient recovered completely after treatment. This report highlights that confirmation of the diagnosis is essential before performing any procedure that increases the intravertebral pressure and the place should have appropriate facilities to manage complications.
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26
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Abstract
Background Primary tumors are rare and those localized to a single location offer the potential for cure. To achieve this, early recognition of the primary tumor and proper workup and treatment are essential. Methods The authors reviewed the literature and best practices to provide recommendations on primary spine tumor treatment. Appropriate workup of primary spine tumors and treatment algorithms are also discussed. Results Patients suspected of a primary spine tumor should undergo fine-needle aspirate biopsy following consultation with the surgical team to ensure the biopsy tract is surgically resectable should the need arise. Once pathology is confirmed, metastatic workup should be performed to guide the level of treatment. If a localized lesion with poor radiation and chemotherapeutic response is diagnosed, then en bloc resection may be required for cure. If en bloc resection is not feasible or metastatic lesions are present, then radiation and medical oncology specialists must work in conjunction with the surgical team to determine the best treatment options. Conclusions Patients with suspected primary tumors of the spine should be treated in a multidisciplinary fashion from the outset. With thoughtful management, these lesions offer the opportunity for surgical cure.
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Affiliation(s)
- Michelle J. Clarke
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Ehud Mendel
- Department of Neurosurgery and Orthopedics, Ohio State University, Columbus, Ohio
| | - Frank D. Vrionis
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
- Departments of Neurosurgery and Orthopedics, University of South Florida Morsani College of Medicine, Tampa, Florida
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Wijeratna MD, Cook AJ, Powell J. A novel use of colonoscopy forceps for biopsy of intervertebral disc. Ann R Coll Surg Engl 2013. [PMID: 23485006 PMCID: PMC4098590 DOI: 10.1308/003588413x13511609958055e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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28
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Wijeratna MD, Cook AJ, Powell J. A novel use of colonoscopy forceps for biopsy of intervertebral disc. Ann R Coll Surg Engl 2013; 95:157. [DOI: 10.1308/rcsann.2013.95.2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - AJ Cook
- Ipswich Hospital NHS Trust, UK
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29
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Percutaneous needle biopsy in diagnosis and identification of causative organisms in cases of suspected vertebral osteomyelitis. Eur J Radiol 2012; 81:940-6. [DOI: 10.1016/j.ejrad.2011.01.125] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/17/2011] [Accepted: 01/28/2011] [Indexed: 11/24/2022]
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30
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Buyukbebeci O, Karakurum G, Tutar E, Gulec A, Arpacioglu O. Biopsy of vertebral tumour metastasis for diagnosing unknown primaries. J Orthop Surg (Hong Kong) 2010; 18:361-3. [PMID: 21187552 DOI: 10.1177/230949901001800321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To examine patients with vertebral tumour metastasis using transpedicular biopsy for diagnosing unknown primary tumours. METHODS 13 men and 8 women aged 41 to 80 (mean, 61) years with vertebral tumour metastasis of unknown primary origin underwent transpedicular biopsy of the affected vertebra. RESULTS The origins of the primary tumours were lung cancer (n = 6), prostate cancer (n = 5), colorectal cancer (n = 5), kidney cancer (n = 4) and lymphoma (n = 1). All the specimens matched pathological characteristics of their corresponding primary tumours, except in one patient. This 42-year-old man had stage-4 colon cancer, in whom the pathologic findings could not enable differentiation between colon and prostate cancer. CONCLUSION Transpedicular biopsy of the vertebra is a cost-effective diagnostic tool for evaluating unknown primary tumours.
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Affiliation(s)
- Orhan Buyukbebeci
- Orthopaedics and Traumatology Department, Medicine Faculty, Gaziantep University, Gaziantep, Turkey
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Venturi C, Barbero S, Tappero C, Ciccone V, Mastrogiacomo F, Molinaro L, Gandini G. Coaxial biopsy during percutaneous vertebroplasty in patients with presumed osteoporotic vertebral compression fractures: retrospective review of biopsy results. Radiol Med 2010; 116:302-9. [PMID: 21076886 DOI: 10.1007/s11547-010-0593-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 02/22/2010] [Indexed: 11/28/2022]
Abstract
PURPOSE This study retrospectively analysed the results of biopsies obtained during percutaneous vertebroplasty (PVP) in patients with presumed osteoporotic vertebral compression fractures, with a view to highlighting the importance of coaxial biopsy in determining the aetiology of vertebral fractures and planning subsequent treatment. MATERIALS AND METHODS Between November 2003 and March 2009, 98 patients (78 women; 20 men) with a clinical and imaging suspicion of osteoporotic vertebral compression fractures underwent coaxial biopsy in conjunction with PVP of the thoracic and lumbar vertebrae. Mean age at the time of the procedure was 72.6 years. A pathologist interpreted all the biopsy samples. RESULTS In 83 patients, the biopsy results were consistent with the presumed osteoporotic aetiology. In two patients, a malignancy was identified. Biopsy samples from 13 patients were considered insufficient or unsuitable by the pathologist for evaluation. CONCLUSIONS Despite the number of biopsy samples considered insufficient or unsuitable, coaxial biopsy during PVP is useful in verifying the presumed aetiology of vertebral compression fractures, which is often unclear on the basis of clinical and imaging examinations. It is therefore both convenient and advisable to perform a vertebral coaxial biopsy in all patients undergoing a PVP.
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Affiliation(s)
- C Venturi
- Department of Radiology, Complex Operational Structure for Radiological Diagnosis, Cardinal Guglielmo Massaia Hospital, Via Conte Verde 125, 14100, Asti, Italy.
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The value of routinely performing a bone biopsy during percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976) 2009; 34:2395-9. [PMID: 19829253 DOI: 10.1097/brs.0b013e3181b8707e] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN 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. SUMMARY OF BACKGROUND DATA 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. CONCLUSION 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.
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Rezanko T, Sucu HK, Akkalp A, Tunakan M, Sari A, Minoglu M, Bolat B. Is it possible to start the treatment based on immediate cytologic evaluation of core needle biopsy of the spinal lesions? Diagn Cytopathol 2008; 36:478-84. [PMID: 18528885 DOI: 10.1002/dc.20834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Core needle biopsy is widely used to diagnose spinal lesions. Final histopathological report of the specimen usually can be given after several days. These several days delay may prevent early treatment in some patients. Our aim was to investigate if treatment of spinal lesions could be started according to the immediate cytologic evaluation of the core needle biopsy. The cytological materials of the 213 core needle spinal biopsy were prepared immediately after biopsy procedure. Of these biopsies, only 101 core needle biopsy had a final diagnosis which formed the backbone of the current study. Cytological materials of these cases were compared with both histopathologic results of the core biopsy and with final diagnosis obtained by open surgery or clinical follow up. According to final diagnoses 40 patients had infections, 59 patients had neoplasms and 2 patients had no pathology. When the diagnosis that determines the treatment is considered, the overall success rates (positive predictive value:PPV) of cytology and histology were 0.65 and 0.76 respectively. Moreover when the specific diagnosis were analyzed separetely in the subgroups of tuberculous infection, lymphoma and plasmacytoma; PPV of both cytological and histological assessments was 1.00. In spinal metastasis, PPV was 0.97 for cytology and 1.00 for histology. Rapid cytologic interpretation of core needle biopsy material is a useful and reliable tool to determine the spinal lesions which require urgent treatment. When the cytological specimen reveals the diagnosis of spinal metastasis, lymphoma, plasmacytoma or tuberculosis, the treatment may be started without waiting the result of the histological examination.
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Affiliation(s)
- Turkan Rezanko
- Department of Pathology, Izmir Ataturk Training and Research Hospital, Izmir, Turkey.
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