Metastasis in vertebra mimicking acute compression fractures in a patient with osteoporosis

Ho, Chun Sheng; Choi, Wai M.; Chen, Chia Yuen; Chen, Wei-Yu; Chan, Wing P.

doi:10.1016/j.clinimag.2004.04.025

Cited by 10 publications

(16 citation statements)

References 8 publications

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“…However, Allen et al (24) suggested that patients undergoing first-time vertebral augmentation should be considered for vertebral biopsy. The present study and additional studies (4,10,12) have confirmed malignant biopsy results in patients, who did not exhibit any other clinical malignant evidence. However, the rate of detection was low in such cases.…”

Section: Discussionsupporting

confidence: 72%

“…However, in certain cases these pre-operative investigations fail to provide correct diagnosis of the condition (4,10,11). It has been reported that the rate of distinguishing benign and malignant compression fractures of the spine through MRI is between 55 and 94% (13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

“…Diagnosis of osteoporosis is based on clinical and radiological imaging observations, including DEXA examination. However, these processes often do not distinguish between neoplastic and osteoporotic etiology (4).…”

Section: Introductionmentioning

confidence: 99%

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Histological evaluation of bone biopsy results during PVP or PKP of vertebral compression fractures

Zhang¹,

LI²,

Yang³

et al. 2012

Oncology Letters

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Abstract. Percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP) is utilized for the treatment of vertebral compression fractures (VCFswith a history of malignancy, malignancy was identified in 25 patients, while osteoporosis was identified in 16 patients. Biopsies of the other 3 patients were not suitable for pathological examination. There were only 2 patients with previously undiagnosed malignancy. One patient was diagnosed with multiple myeloma, while another patient was diagnosed with metastatic carcinoma. In the present study, the rate of unsuspected malignancy was 0.4%. No symptomatic complications occurred as a result of biopsy. The results indicate that biopsy is safely performed during PVP or PKP and it is an efficacious procedure that verifies the pathological process and assists in identifying previously unsuspected processes responsible for VCFs. We recommend obtaining the biopsy of every collapsed vertebral body during PVP or PKP procedures.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

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Histological evaluation of bone biopsy results during PVP or PKP of vertebral compression fractures

Zhang¹,

LI²,

Yang³

et al. 2012

Oncology Letters

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“…Often, malignant fracture can mimic an osteoporotic compression fracture in radiographic image exams. 67 Meanwhile, patients with known malignancy can present with osteoporotic fractures. 68 In fact, diagnosing a malignant fracture in a patient without cancer history can be difficult.…”

Section: Importance Of Routine Biopsymentioning

confidence: 99%

Controversies on Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures

Teles

Mattei²,

Righesso

et al. 2015

Coluna/Columna

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Vertebroplasty and kyphoplasty are widely used for osteoporotic and cancer-related vertebral compression fractures refractory to medical treatment. Many aspects of these procedures have been extensively discussed in the literature during the last few years. In this article, we perform a critical appraisal of current evidence on effectiveness and ongoing controversies regarding surgical technique, indications and contraindications, clinical outcomes and potential complications of these procedures.

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“…Often, malignant disease can mimic osteoporotic compression fractures and cannot be reliably diagnosed on radiographic interpretation alone. 10 Conversely, in patients with known malignancy, VCFs may not necessarily be secondary to their disease.…”

mentioning

confidence: 99%

Utility of routine biopsy at vertebroplasty in the management of vertebral compression fractures: a tertiary center experience

Mukherjee

Thakur

Bhagawati

et al. 2014

SPI

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Object The authors assess the utility of routine biopsy at vertebroplasty for vertebral compression fracture (VCF) as a tool in the early detection of malignancy in presumed benign VCF. Methods A prospective observational study was conducted on a cohort of consecutive patients undergoing vertebroplasty over a 5-year period between April 2006 and March 2011 at the Royal London Hospital. Polymethylmethacrylate cement injection was used in every procedure. Intraoperative vertebral body biopsy was performed routinely at every level of VCF. Pain visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, analgesic usage, and complications were recorded preoperatively and at 1 day, 1 week, 1 month, 6 months, and 1 year postoperatively. Results A total of 202 levels were augmented in 147 patients. The most common levels augmented were T-12 (17%), L-1 (18%), and L-4 (10%). Analysis of 184 routine vertebral biopsies in 135 patients revealed that in 86 patients with presumed osteoporosis and no prior cancer diagnosis, 4 (4.7%) had a malignant VCF. In 20 known cancer patients presumed to be in remission, 2 (10%) had a malignant VCF. Routine vertebral biopsy returned an overall cancer diagnosis rate of 5.5% (6 of 109) when combining the 2 groups (patients with no prior history of cancer or cancer thought to be in remission). In these 6 patients, history, examination, laboratory tests, and preprocedure imaging all failed to suggest malignancy diagnosed at routine biopsy. Significant reductions in pain VAS and ODI scores were evident at Day 1 and were sustained at up to 1 year postoperatively (p < 0.001). They were not dependent on the level of fracture (T3–10, T11–L2, or L3–S1) (p > 0.05), number of levels treated (single level, 2 levels, or > 2 levels) (p > 0.05), or etiology of VCF (p > 0.05). The complication rate was 6% (9 of 147). There were 5 deaths, none of which were directly related to surgery. Conclusions Routine vertebral biopsy performed at vertebroplasty may demonstrate cancer-related VCFs in unsuspected patients with no previous cancer diagnosis or active malignancy in patients previously thought to be in remission. This early diagnosis of cancer or relapsed disease will play an important role in expediting patients' subsequent cancer management. In cases of multiple-level VCF, the authors advocate biopsy at each level to maximize the diagnostic yield from the specimens and to avoid missing a malignancy at a single level.

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Metastasis in vertebra mimicking acute compression fractures in a patient with osteoporosis

Cited by 10 publications

References 8 publications

Histological evaluation of bone biopsy results during PVP or PKP of vertebral compression fractures

Histological evaluation of bone biopsy results during PVP or PKP of vertebral compression fractures

Controversies on Vertebroplasty and Kyphoplasty for Vertebral Compression Fractures

Utility of routine biopsy at vertebroplasty in the management of vertebral compression fractures: a tertiary center experience

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