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

Abstract

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.

Extrapedicular vs transpedicular percutaneous kyphoplasty for osteoporotic vertebral compression fractures: A systematic review and meta-analysis

“…We also nd the extrapedicular kyphoplasty group need less bone cement than the transpedicular kyphoplasty group. Yan et al [40,41] described that facing the small pedicle of the thoracic spine and the small included angle between the longitudinal axis of the pedicle and the sagittal plane, it is di cult for pedicle approach to reach the target with a large lateral angle. These reasons may be cause the amount of bone cement injected in the extrapedicular kyphoplasty group is usually less than the extrapedicular kyphoplasty group.…”

Stellenwert der transpedikulären Biopsie bei Kypho- und Vertebroplastien von Wirbelkörperfrakturen

“…Eine Literaturrecherche der Autoren dieser Umfrage ergab, dass routinemäßige transpedikuläre Biopsien bei Kypho- oder Vertebroplastien von Kompressionsfrakturen der Wirbelsäule in 0,4 bis zu 6 % zur Diagnose bisher unbekannter Krebserkrankungen (primär und metastasiert) führen [ 6 , 8 , 11 – 13 , 15 , 16 , 19 , 20 ]. Im Bezug darauf wurden die Teilnehmer gefragt, ob sie angesichts dieser Ergebnisse den Stellenwert der Biopsien anders gewichten würden.…”