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Routine needle biopsy during vertebral augmentation procedures. Is it necessary?

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Abstract

Vertebral augmentation procedures are currently widely performed to treat vertebral compression fractures. The purpose of this study was to determine the frequency of underlying previously unrecognized etiology in a consecutive series of patients undergoing kyphoplasty to treat vertebral compression fractures. A prospective histological evaluation of vertebral body biopsy specimens from presumed osteoporotic vertebral compression fractures were performed in order to identify aforementioned causes. Over a 2-year period, vertebral body biopsies from 154 vertebral levels were performed in 75 patients undergoing kyphoplasty for vertebral compression fractures. All patients received a preoperative workup that included plain radiographs, MRI, whole body bone scan, and laboratory examinations. Bone specimens were obtained from affected vertebral bodies and submitted for histologic evaluation to identify the prevalence of an underlying cause. All specimens demonstrated fragmented bone with variable amounts of unmineralised bone, signs of bone-remodeling and/or fracture-healing. In 11 patients underlying pathology other than osteoporosis was identified (prostate cancer, 1; pancreatic cancer, 1; colon cancer, 1; breast cancer, 2; multiple myeloma, 3; leukemia, 1; and lung cancer, 2). In all but one patient the results of the biopsy confirmed the diagnosis suspected from the preoperative workup. For the last patient, namely the one with pancreatic cancer, the workup did not identify the origin of the primary tumor, although the patient was considered to have a compression fracture secondary to metastatic disease of unknown origin, the vertebral biopsy suggested the presence of adenocarcinoma which eventually was proven to be pancreatic cancer. In augmentation procedures for vertebral compression fractures, bone biopsy should be reserved for the patients where the preoperative evaluation raises the suspicion of a non-osteoporotic etiology.

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Authors and Affiliations

  1. 3rd Department of Orthopaedic Surgery, University of Athens Medical School, Athens, Greece

    Spiros G. Pneumaticos & Dimitrios S. Korres

  2. KAT Hospital, Nikis 2, 145 61, Kifissia, Greece

    Spiros G. Pneumaticos & Dimitrios S. Korres

  3. 2nd Department of Radiology, University of Athens Medical School, Athens, Greece

    Sofia N. Chatziioannou

  4. Attikon General Hospital, Rimini 1, 12 464, Chaidari, Greece

    Sofia N. Chatziioannou

  5. 2nd Department of Orthopaedic Surgery, University of Athens Medical School, Athens, Greece

    Christiana Savvidou & Anastasia Pilichou

  6. Agia Olga Hospital, 3-5 Agias Olgas Str., 142 33, Athens, Greece

    Christiana Savvidou & Anastasia Pilichou

  7. Department of Pathology, Evangelismos Hospital, Ipsilantou 45-47, 106 76, Athens, Greece

    Dimitra Rontogianni

Authors
  1. Spiros G. Pneumaticos
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  2. Sofia N. Chatziioannou
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  3. Christiana Savvidou
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  4. Anastasia Pilichou
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  5. Dimitra Rontogianni
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  6. Dimitrios S. Korres
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Correspondence to Spiros G. Pneumaticos.

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Pneumaticos, S.G., Chatziioannou, S.N., Savvidou, C. et al. Routine needle biopsy during vertebral augmentation procedures. Is it necessary?. Eur Spine J 19, 1894–1898 (2010). https://doi.org/10.1007/s00586-010-1388-8

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  • DOI: https://doi.org/10.1007/s00586-010-1388-8

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