Introduction: Efficacy of Routine Biopsy at Vertebral Augmentation for Compression Fracture Repair in the Early Detection of Malignancy in Presumed Benign VCF.
Methods: The authors assess the utility of routine biopsy at vertebral augmentation for compression fracture (VCF) as a tool in the early detection of malignancy in presumed benign VCF.
Results: A total of three levels were augmented in 327 procedures (256 patients, µ age = 75.2yr). The most common levels augmented were L-1 (64.5%), and L-2 (31.2%). Analysis of 271 routine vertebral biopsies in 256 patients revealed two (0.7%) pathologic VCF. Routine vertebral biopsy returned an overall cancer diagnosis rate of 1.1% (3 of 256) when combining the 2 groups (patients with no prior history of cancer or cancer thought to be in remission). In these 3 patients, history, examination, laboratory tests, and pre-procedure imaging all failed to suggest malignancy diagnosed at routine biopsy. There were 92 (28.4%) patients with fractures of adjacent vertebra (13.0% inferior, 15.4% superior). VAS and ODI scores demonstrated significant pain and disability improvement that was evident at week 12 and was sustained at up to 1 year postoperatively (p<0.01). They were not dependent on the number of levels treated (1 vs >1 levels) (p>0.05), or etiology of VCF (p>0.05). Twelve patients (4.7%) had persistent pain not associated with their VCF.
Conclusions: Routine vertebral biopsy performed during vertebral augmentation kyphoplasty does not demonstrate cancer-related VCF’s in unsuspected patients with no previous cancer diagnosis or active malignancy. There was significant improvement in disability at 12 weeks and one year. Adjacent level fractures were more likely superior to the treated level. The twelve patients with persistent pain may be due to other symptomatic osteoporotic levels in relation to height preservation. This pain may be a result of undiagnosed/untreated fracture rather than a failure of symptomatic treatment.
Patient Care: Clinician will be selective in biopsy of vertebral augmentation patients in order to get the highest yield from the biopsy results.
Learning Objectives: To understand when to biopsy during vertebroplasty or kyphoplasty procedures.