Category: Diagnosis and Risk Assessment

11 - Efficacy of Routine Biopsy at Vertebral Augmentation for Compression Fracture Repair in the Early Detection of Malignancy in Presumed Benign VCF

Objective: To assess the utility of routine biopsy at vertebral augmentation for compression fracture as a tool in the early detection of malignancy in presumed benign vertebral compression fracture

Retrospective study conducted on a cohort of consecutive patients undergoing vertebral augmentation between January 2009 and December 2013. 410-bed community teaching hospital. Polymethylmethacrylate cement injection used in every procedure. Intraoperative vertebral body biopsy was performed routinely at every level of VCF. Outcome Measures included the pain visual analog scale (VAS), Oswestry Disability Index (ODI), analgesic use, and complications recorded pre and post operatively up to three years.

Three different anatomic levels were performed in 327 procedures (256 patients, Age: ยต=75.2y). L-1 (64.5%), L-2 (31.2%). In 271 routine vertebral biopsies (256 patients) revealed 25 (9.2%) abnormal biopsy findings. Routine vertebral biopsy returned an overall cancer diagnosis rate of 1.1% (3 of 256) when combining patients with no history of cancer or cancer in remission. In these 3 patients: history, exam, lab tests, and pre-procedure imaging failed to suggest malignancy. 92 (28.4%) patients had fractures of adjacent vertebra (13% inferior, 15.4% superior). VAS and ODI scores demonstrated significant pain and disability improvement at week 12 (p < 0.01). Improvement was sustained up to 1 year (p < 0.01). This was not dependent on the number of levels treated (1 vs >1) (p>0.05), or etiology of VCF (p>0.05). 12 patients (4.7%) had persistent pain not associated with their VCF. Complication rate was 1.3% (4 of 304). There were 37 deaths, none of which were related to surgery.

Routine vertebral biopsy performed during vertebral augmentation kyphoplasty does not demonstrate cancer-related VC fractures in unsuspected patients with no previous cancer diagnosis or active malignancy. Adjacent level fractures were more likely to be superior to the treated level. 12 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.

Kimberly Barber

director of Clinical and Academic Research
Genesys Regional Medical Center
grand Blanc, Michigan

Avery M. Jackson

Michigan Neurosurgical Institute
Grand Blanc, Michigan