Incidence of unexpected positive histology in kyphoplasty

Nowak, Stephan; Müller, J.; Schroeder, Henry W. S.; Müller, Jan Uwe

doi:10.1007/s00586-017-5458-z

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…In our study, the biopsy results of three patients were positive and the filing of a possible malpractice suit was prevented. Of note, in our series, 13 pathology reports included insufficient material; however, this is consistent with the literature (15), and is also legally safe for the clinician because of the biopsies (14).…”

Section: Resultssupporting

confidence: 89%

“…These authors also reported on the specific increase of neurosurgical medicolegal cases (12). Nowak et al suggested that the incidence of positive histology in PBK is high and, if no biopsy is taken, malpractice will be alleged (14). In our study, the biopsy results of three patients were positive and the filing of a possible malpractice suit was prevented.…”

Section: Resultssupporting

confidence: 55%

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Kyphoplasty in the early oncologic diagnosis and treatment of vertebral fractures: a clinical study

Akyuva

Baysoy²,

Savrunlu³

et al. 2020

Turkish Neurosurgery

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AIM: To elucidate the characteristics of kyphoplasty in correlation with spinal metastasis. MATERIAL and METHODS: Data of patients treated by kyphoplasty between January 2017 and December 2019 were reviewed retrospectively. Preoperative prophylactic antibiotics and low-molecular-weight heparin injections were performed. Postoperative follow-up was conducted at least 24 hours after the procedure. All patients were treated under sedoanalgesia. Bone biopsies were collected from all patients. RESULTS: One hundred ninety-nine vertebra fractures were treated in 130 patients. The mean age of the patients was 65.27 ± 8.79 years (18-90 years) and 66 patients were male (50.7%). Forty-five patients had osteoporosis, six patients showed malignancy, and osteomyelitis was found in three patients, while the others' presentations were secondary to trauma. Most commonly, the L1 (n=59), Th12 (n=45), and L2 (n=34) levels were found to develop vertebral fractures. Forty patients had multiple levels of vertebral fracture, with a higher rate of osteoporosis (n=24; 60%). Three patients showed undiagnosed oncologic disease with an initial diagnosis of acute fracture following minor trauma, while the primary oncologic diagnosis was established by bone biopsy taken during the routine procedure in each procedure (e.g., plasmacytoma, lymphoma, adenocarcinoma of the lung). None of the patients developed an infection due to kyphoplasty, permanent neuromotor deficit, or mortality. The mean postoperative hospital length of stay was 1.6 days. CONCLUSION: Bone biopsy should be performed to diagnose early spinal metastases. Although an accurate bone biopsy may not be obtained from some patients, particularly from those with osteoporosis, performing bone biopsy during the procedure does not cause time loss or any other complications, and protects the surgeon from possible medicolegal problems.

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Section: Resultssupporting

confidence: 89%

Section: Resultssupporting

confidence: 55%

Kyphoplasty in the early oncologic diagnosis and treatment of vertebral fractures: a clinical study

Akyuva

Baysoy²,

Savrunlu³

et al. 2020

Turkish Neurosurgery

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“…Other investigations reported significantly higher incidence rates of unsuspected malignancy in biopsies during vertebroplasty and came to similar conclusions [9]. Hansen [10][11][12][13]. Based on their results, Li et al further analyzed the economic burden due to routine biopsy.…”

Section: Resultsmentioning

confidence: 57%

“…One study did not report on the modality of preoperative imaging. Studies combining a bone scan with an MRI had unexpected malignancies in 1–3% only [ 11 , 18 , 19 ], compared to 0.4–6% in studies using an MRI [ 8 , 10 , 12 – 17 , 20 , 21 ], and 6% in the one study reporting on unexpected lesions using CT only [ 22 ].…”

Section: Resultsmentioning

confidence: 99%

The role of routine transpedicular biopsies during kyphoplasty or vertebroplasty for vertebral compression fractures in the detection of malignant diseases: a systematic review

Osterhoff

Scheyerer

Spiegl

et al. 2022

Arch Orthop Trauma Surg

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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.

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“…Biopsy is not performed routinely with these procedures based on the hypothesis that most VCFs are secondary to osteoporosis. However, it is well established that VCFs secondary to malignancy are a relatively common etiology as well 8–10 . Although the exact incidence of malignancy varies based on the study quoted, it has been reported to be as high as 10% to 15% 9,11,12 …”

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confidence: 99%

Role of Bone Biopsy During Kyphoplasty in the Setting of Known Cancer

Tariq

Obedian

2021

Spine

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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 formalignancyotherthanthepatient'sknownprostatecancer. 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 preventsincorrectpresumptionssuchasinthiscase.

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Incidence of unexpected positive histology in kyphoplasty

Cited by 11 publications

References 11 publications

Kyphoplasty in the early oncologic diagnosis and treatment of vertebral fractures: a clinical study

Kyphoplasty in the early oncologic diagnosis and treatment of vertebral fractures: a clinical study

The role of routine transpedicular biopsies during kyphoplasty or vertebroplasty for vertebral compression fractures in the detection of malignant diseases: a systematic review

Role of Bone Biopsy During Kyphoplasty in the Setting of Known Cancer

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