1
|
Osterhoff G, Rappert D, Scheyerer MJ, Disch AC, Ullrich BW, Spiegl UA, Schnake KJ. [Value of routine transpedicular biopsies in kyphoplasty and vertebroplasty for vertebral compression fractures : A survey among 250 spine surgeons]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:873-879. [PMID: 35838762 PMCID: PMC10627954 DOI: 10.1007/s00113-022-01210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Transpedicular cement augmentation is an established therapeutic option in the treatment of pathologic compression fractures of the spine. In addition to osteoporosis, underlying metastatic diseases or, more rarely, a primary bone tumor are recurrent causes of vertebral compression fractures without adequate trauma. OBJECTIVE To obtain a current opinion among spine surgeons in Germany, Switzerland, and Austria on the value of transpedicular biopsy during kyphoplasty and vertebroplasty of vertebral body fractures. MATERIAL AND METHODS A web-based (UmfrageOnline®) questionnaire with 11 questions was created and sent to the email distribution lists of the German Spine Society (DWG), the Austrian Society for Spine Surgery (spine.at), and the Swiss Society for Spinal Surgery (SGS), as well as to the email distribution list of the Spine Section of the German Society for Orthopedics and Trauma Surgery (DGOU). RESULTS Of a total of 2675 spine surgeons contacted 250 (9.3%) responded to the survey. Approximately one third (29.8%) of respondents regularly perform a transpedicular biopsy with each kyphoplasty or vertebroplasty. Reasons cited for biopsy were image morphology (79.7%) or history of suspected (66.0%) or present (71.4%) tumor disease. Reasons cited against routine biopsy were the associated costs and the limited informative value of the biopsies obtained. DISCUSSION Nearly one third of the spine surgeons surveyed regularly perform a transpedicular biopsy with each kyphoplasty or vertebroplasty. Almost all respondents perform biopsies at least when there is an imaging morphologic suspicion of tumor disease or tumor disease is known or suspected based on risk factors. Future studies need to further clarify the cost-effectiveness of transpedicular biopsy.
Collapse
Affiliation(s)
- Georg Osterhoff
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - Denis Rappert
- Interdisziplinäres Zentrum f. Wirbelsäulen- und Skoliosetherapie, Malteser Waldkrankenhaus St., Marien Rathsberger Str. 57, 91054, Erlangen, Deutschland
| | - Max J Scheyerer
- Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Straße 62, 50937, Köln, Deutschland
| | - Alexander C Disch
- UniversitätsWirbelsäulenzentrum (UCSC), UniversitätsCentrum für Orthopädie, Unfall- & Plastische Chirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fiedlerstraße 19, 01307, Dresden, Deutschland
| | - Bernhard W Ullrich
- Klinik für Unfall- und Wiederherstellungschirurgie, BG Klinikum Bergmannstrost GgmbH Halle, Merseburger Straße 165, 06112, Halle (Saale), Deutschland
- Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Jena, Friedrich Schiller Universität Jena, 07747, Jena, Deutschland
| | - Ulrich A Spiegl
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland
| | - Klaus J Schnake
- Interdisziplinäres Zentrum f. Wirbelsäulen- und Skoliosetherapie, Malteser Waldkrankenhaus St., Marien Rathsberger Str. 57, 91054, Erlangen, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Nürnberg Süd, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nürnberg, Deutschland
| |
Collapse
|
2
|
Osterhoff G, Scheyerer MJ, Spiegl UJA, Schnake KJ. The role of routine transpedicular biopsies during kyphoplasty or vertebroplasty for vertebral compression fractures in the detection of malignant diseases: a systematic review. Arch Orthop Trauma Surg 2023; 143:1887-1893. [PMID: 35233719 PMCID: PMC10030449 DOI: 10.1007/s00402-022-04392-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 02/12/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Procedures like kyphoplasty or vertebroplasty have become an established treatment option for vertebral compression fractures (VCF). The transpedicular approach used during these procedures allows to take biopsies from the affected vertebral body. The aim of this study was to systematically summarize the existing knowledge on the value of routine transpedicular biopsies during kyphoplasty or vertebroplasty for vertebral compression fractures. METHODS A systematic review of the literature using PubMed/Medline databases with the goal of finding all articles describing the value trans-pedicular biopsies for detecting primary bone tumors, metastases, bone diseases, or spondylitis in patients with vertebral compression fractures was performed. Search terms were (*biopsy/ OR biops*.ti,ab.) AND (vertebral compression fracture*.ti,ab.). RESULTS Sixteen articles met the inclusion criteria, among these were six prospective and ten retrospective case series. Publication dates ranged from 2005 to 2020. A total of 3083 patients with 3667 transpedicular biopsies performed were included. Most biopsies confirmed osteoporosis as the dominant underlying pathology of VCFs. Transpedicular biopsies revealed an unexpected malignant diagnosis in 0.4-6% of the cases. CONCLUSION Routine transpedicular biopsies during kyphoplasty or vertebroplasty detect unexpected malignant lesions in 0.4-6% of the patients, even though the definition of "unexpected" varies among the analyzed studies. The evidence to support a routine biopsy is inconsistent. Nevertheless, routine biopsies can be considered, especially when sufficient preoperatvie imaging is not available or radiological findings are unclear.
Collapse
Affiliation(s)
- Georg Osterhoff
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany.
| | - Max J Scheyerer
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Ulrich J A Spiegl
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Klaus J Schnake
- Center for Spinal and Scoliosis Surgery, Malteser Waldkrankenhaus St. Marien, Erlangen, Germany
- Department of Orthopedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany
| |
Collapse
|
3
|
Xiang QQ, Chu B, Lu MQ, Shi L, Gao S, Wang YT, Fang LJ, Ding YH, Zhao X, Chen Y, Wang MZ, Hu WK, Wang LF, Sun K, Bao L. Risk-benefit ratio of percutaneous kyphoplasty and percutaneous vertebroplasty in patients with newly diagnosed multiple myeloma with vertebral fracture: a single-center retrospective study. Ann Hematol 2023; 102:1513-1522. [PMID: 36997718 PMCID: PMC10182123 DOI: 10.1007/s00277-023-05202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/25/2023] [Indexed: 04/01/2023]
Abstract
The indications for percutaneous kyphoplasty (PKP) and percutaneous vertebroplasty (PVP) are painful vertebral compression fractures. Our study is to assess the risk-benefit ratio of PKP/PVP surgery in the patients with newly diagnosed multiple myeloma (NDMM) without receiving antimyeloma therapy. The clinical data of 426 consecutive patients with NDMM admitted to our center from February 2012 to April 2022 were retrospectively analyzed. The baseline data, postoperative pain relief, the proportion of recurrent vertebral fractures, and survival time were compared between the PKP/PVP surgical group and the nonsurgical group in the NDMM patients. Of the 426 patients with NDMM, 206 patients had vertebral fractures (206/426, 48.4%). Of these, 32 (32/206, 15.5%) underwent PKP/PVP surgery for misdiagnosis of simple osteoporosis prior to diagnosis of MM (surgical group), and the other 174 (174/206, 84.5%) did not undergo surgical treatment prior to definitive diagnosis of MM (non-surgical group). The median age of patients in the surgical and nonsurgical groups was 66 and 62 years, respectively (p = 0.01). The proportion of patients with advanced ISS and RISS stages was higher in the surgical group (ISS stage II + III 96.9% vs. 71.8%, p = 0.03; RISS stage III 96.9% vs. 71%, p = 0.01). Postoperatively, 10 patients (31.3%) never experienced pain relief and 20 patients (62.5%) experienced short-term pain relief with a median duration of relief of 2.6 months (0.2-24.1 months). Postoperative fractures of vertebrae other than the surgical site occurred in 24 patients (75%) in the surgical group, with a median time of 4.4 months postoperatively (0.4-86.8 months). Vertebral fractures other than the fracture site at the first visit occurred in 5 patients (2.9%) in the nonoperative group at the time of diagnosis of MM, with a median time of 11.9 months after the first visit (3.5-12.6 months). The incidence of secondary fractures was significantly higher in the surgical group than in the nonsurgical group (75% vs. 2.9%, p = 0.001). The time interval between the first visit and definitive diagnosis of MM was longer in the surgical group than in the nonsurgical group (6.1 months vs. 1.6 months, p = 0.01). At a median follow-up of 32 months (0.3-123 months), median overall survival (OS) was significantly shorter in the surgical group than in the nonsurgical group (48.2 months vs. 66 months, p = 0.04). Application of PKP/PVP surgery for pain relief in NDMM patients without antimyeloma therapy has a limited effect and a high risk of new vertebral fractures after surgery. Therefore, patients with NDMM may need to have their disease controlled with antimyeloma therapy prior to any consideration for PKP/PVP surgery.
Collapse
Affiliation(s)
- Qiu-Qing Xiang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Bin Chu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Min-Qiu Lu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Lei Shi
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Shan Gao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-Tong Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li-Juan Fang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yue-Hua Ding
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Xin Zhao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Yuan Chen
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Meng-Zhen Wang
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Wei-Kai Hu
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li-Fang Wang
- Department of Epidemiology and Statistics, Beijing Jishuitan Hospital, Beijing, China
| | - Kai Sun
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China
| | - Li Bao
- Department of Hematology, Beijing Jishuitan Hospital, Beijing, China.
| |
Collapse
|
4
|
Tariq MB, Obedian R. Role of Bone Biopsy During Kyphoplasty in the Setting of Known Cancer: A Case Report. Spine (Phila Pa 1976) 2021; 46:E1220-E1224. [PMID: 34381001 DOI: 10.1097/brs.0000000000004194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE The aim of this study was to emphasize the utility of routine biopsy during kyphoplasty and to report on a unique case of a patient with known history of prostate cancer found to have a new metastatic cancer. SUMMARY OF BACKGROUND DATA Vertebral compression fractures (VCFs) may cause debilitating pain with nearly one-third of them leading to chronic pain resulting in a tremendous impact on quality of life in patients. Kyphoplasty has been established as an effective means of surgical treatment. However, routine biopsy during kyphoplasty is presently not the standard of care under the presumption that most VCFs are caused by osteoporosis. The role of biopsy in the setting of known malignancy with multiple other risk factors for VCFs is not well understood. METHODS We report on a case of a 73-year-old male with known prostate cancer presenting with persistent unremitting low back pain failing conservative management. Patient develops multiple VCFs in the course of 6 months and is treated with multiple kyphoplasties. Routine biopsy at each level is negative until the last kyphoplasty results positive for malignancy. Surprisingly, the pathology is positive for malignancy other than the patient's known prostate cancer. RESULTS Pathology results prompt oncology workup on the patient which reveals multiple metastases and a new diagnosis of adenocarcinoma of possible upper gastrointestinal origin. In addition, patient's known prostate cancer is also noted to be active. Patient is subsequently started on chemotherapy. CONCLUSION We highlight the utility of routine biopsy during kyphoplasty especially in patients with known history of malignancy. We emphasize that presumptions about the etiology of a VCF are difficult to make with multiple risk factors and that routine biopsy prevents incorrect presumptions such as in this case.Level of Evidence: 5.
Collapse
Affiliation(s)
- Muhammad B Tariq
- NYU Langone Hospital- Long Island, Department of Orthopedic Surgery, Mineola, NY
| | | |
Collapse
|
5
|
Uzunoglu I, Kaya I, Sucu HK, Kizmazoglu C, Sevin IE, Aydin HE, Rezanko TA, Yuceer N. Evaluation of Incidentally Detected Pathology Results of Patients with Vertebral Fracture Treated by Vertebroplasty and Kyphoplasty: A Retrospective Study. World Neurosurg 2019; 122:e639-e646. [DOI: 10.1016/j.wneu.2018.10.116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/16/2018] [Accepted: 10/19/2018] [Indexed: 01/09/2023]
|
6
|
Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures. Asian Spine J 2016; 10:925-929. [PMID: 27790322 PMCID: PMC5081329 DOI: 10.4184/asj.2016.10.5.925] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/30/2016] [Accepted: 02/21/2016] [Indexed: 11/30/2022] Open
Abstract
Study Design Retrospective observational study. Purpose To identify the role of percutaneous vertebral biopsy in histopathological diagnosis of vertebral compression fractures and to identify the frequency of unexpected malignancy in vertebral compression fractures. Overview of Literature Vertebral compression fractures are common in the Indian population. Magnetic resonance imaging and nuclear imaging have some limitations in the diagnosis of definitive pathology of vertebral compression fractures. Therefore, histological confirmation is necessary for definitive diagnosis and to plan appropriate management for patient. Methods A retrospective observational study was conducted involving 84 patients who underwent percutaneous vertebral biopsy between 2010 and 2014. We performed C-arm guided percutaneous transpedicular core vertebral biopsy of vertebral compression fractures under combination of local anesthesia and intravenous conscious sedation. Results Sufficient biopsy material was obtained in 79 of the 84 cases. In the other five cases, biopsy material was not sufficient for reporting. Out of the 79 cases, osteoporotic pathology was detected in 69 patients, malignancy was detected in 8 patients and no pathology was found in 2 patients. Two patients with distant metastases to vertebra were identified. Primary spinal malignancy was detected in 6 patients (1 unsuspected plasmacytoma, 5 diagnosed malignancy preoperatively). So, the frequency of unsuspected malignancy of this study was 1.19% (1/84). None of the patients had any complications. Conclusions C-arm guided percutaneous transpedicular vertebral biopsy is useful in obtaining definitive histopathological diagnosis of vertebral compression fractures, especially in differentiating malignant and non-malignant vertebral compression fractures and helping plan appropriate management of patients. The rate of unexpected malignancy in vertebral compression fracture was 1.19%.
Collapse
|