Simple transpedicular vertebral biopsy for diagnosis of malignancy in vertebral compression fracture

Abstract

Background: The transpedicular route in percutaneous vertebroplasty (PVP) is a well-established approach for the treatment of vertebral compression fractures (VCFs). However, the value of simple transpedicular biopsy in VCFs is less addressed. The purpose of this study is to evaluate the value of transpedicular biopsy during PVP for uncovering the malignancy in VCFs in a 10-year retrospective study.

Materials and methods: During the study period of the 1019 patients who underwent PVP for VCFs, 450 patients comprising of 127 male and 323 female underwent transpedicular biopsy during PVP for 705 fractured vertebras. The medical records were analyzed for age, gender, imaging studies, operation notes, pre-operative and post-operative diagnoses, date of vertebroplasty and biopsy, vertebral level and pathological reports.

Results: Pathology of the specimens of the 450 patients confirmed non-malignant VCFs in 389 (86.44%) and malignancy in 61 (13.56%). The malignant pathology included: 52 (11.56%) distant metastases to vertebra, in 3 (0.67%) of the spinal metastases was unsuspected and in 49 (10.89%) of them the malignancy was suspected pre-operatively. There were 9 (2%) primary spinal malignancies, 2 (0.44%) unsuspected multiple myeloma and 7 (1.56%) pre-operatively suspected primary malignancies. The frequency of unsuspected malignancy was 1.11% (5/450) in this study. There was no complication associated with transpedicular biopsy during PVP.

Conclusions: VCFs harbored 1.11% of unexpected malignancy. During the vertebroplasty, concomitant transpedicular vertebral biopsy is a safe and useful procedure for distinguishing non-malignant from malignant compression fractures, especially in diagnosing unsuspected malignancy.