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The Value of Routinely Performing a Bone Biopsy During Percutaneous Vertebroplasty in Treatment of Osteoporotic Vertebral Compression Fractures

Muijs, Sander Paul Jan MD*; Akkermans, Paul A. BSc*; van Erkel, Arian R. MD, PhD; Dijkstra, Sander D. MD, PhD*

doi: 10.1097/BRS.0b013e3181b8707e
Clinical Case Series

Study Design. A retrospective histologic evaluation of biopsies obtained during percutaneous vertebroplasty (PVP) procedures as treatment for presumed osteoporotic vertebral compression fractures.

Objective. To determine the rate of unsuspected malignancy in bone biopsies of patients undergoing PVP for osteoporotic vertebral compression fractures.

Summary of Background Data. Most vertebral compression fractures, which result from minimal, or no trauma have osteoporosis as underlying cause. The diagnosis osteoporosis is based on clinical and radiologic findings. Even in patients with proven osteoporosis it is not always the true cause of the fractures. In literature, outcomes of bone-biopsies obtained during vertebroplasty have been described with inconsistent percentages of unexpected malignancy.

Methods. To determine the rate of unsuspected malignancy, 78 biopsies were obtained from 78 patients (18 male; 60 female; mean age, 73 years). The histologic diagnoses of vertebral body biopsy specimens were analyzed in a retrospective study.

Results. Seventy-one biopsies (91%) obtained from 71 patients, were suitable for histologic evaluation. Seven biopsies (9.0%) could not be interpreted as a result of suboptimal quality biopsy material. The population included 10 patients (13%) with a history of malignancy, in this group no malignancy was found in the bone biopsies. In 3 patients (3.8% of all biopsies) previously undiagnosed malignancies, 2 multiple myeloma stage IIa and 1 chondrosarcoma grade I, were found.

Conclusion. Obtaining bone biopsies during PVPs does not lead to increased morbidity and can verify the pathologic process underlying the vertebral compression fractures. Since this study showed an unsuspected malignancy rate of 3.8%, we recommend routine obtainment of a vertebral body bone biopsy, preferably using a biopsy needle with a diameter larger than 14 Gauge (>2.1 mm/0.083 inch), during every PVP procedure.

In this study an evaluation of the histologic outcome of bone biopsies obtained during percutaneous vertebroplasty as treatment for 141 osteoporotic vertebral compression fractures in 78 patients was conducted to determine the rate of unsuspected malignancy. Seventy-one biopsies (91%) obtained from 71 patients, were suitable for histologic evaluation. In 3.8% of all biopsies previously undiagnosed malignancies were found.

From the Departments of *Orthopaedic Surgery, and †Radiology, Leiden University Medical Center, Leiden, The Netherlands.

Acknowledgment date: September 24, 2008. Revision date: December 1, 2008. Acceptance date: December 3, 2008.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

This study has been approved by the Ethics Committee of the Leiden University Medical Center The Netherlands reference: 08/36B/NV/nv.

Address correspondence and reprint requests to Sander D. Dijkstra, MD, PhD, Department of Orthopaedic Surgery, Leiden University Medical Center, Albinusdreef 2, P.O. Box 9600, 2300 RC Leiden, The Netherlands; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.