Schoenfeld Andrew J, Dinicola Nicholas J, Ehrler Douglas M, Koerber Andrea, Paxos Mihail, Shorten Scott D, Bowers Jacqueline, Jackson Erin, Smith Michael J
Department of Orthopaedic Surgery, Northeastern Ohio Universities College of Medicine, Akron, OH, United States.
Injury. 2008 Mar;39(3):327-33. doi: 10.1016/j.injury.2007.06.019. Epub 2007 Sep 18.
Percutaneous vertebral body fixation has been found to provide pain relief and restoration of function for patients with compression fractures. Despite the prevalence of osteoporosis, there are a variety of aetiologies, such as lymphoma, myeloma or metastatic disease that may be responsible for the condition. In these instances, vertebral body biopsy can play an important role in determining fracture aetiology and assist in initiating concurrent medical treatment.
Between 2002 and 2005, 80 vertebral body biopsies were performed in conjunction with percutaneous augmentation procedures on 50 patients at our teaching institution. Eleven biopsies were performed during vertebroplasty and 69 were performed during kyphoplasty. The mean age at the time of procedure was 75.7 years. Eight patients were male and 42 were female. A pathologist interpreted all biopsy samples and all charts were reviewed examining past history, diagnoses prior to compression fracture, biopsy results and post-op conditions that developed or were diagnosed after surgery.
All patients healed their compression fractures following surgery and no complications were experienced. Eleven patients had a diagnosis of osteoporosis prior to vertebral fracture, while 8 patients had a malignant condition initially suspected as being responsible for the compression fracture. Malignancy was identified in 4 patients, 3 of whom did not previously have such a diagnosis. In an additional 6 cases the suspected aetiology behind vertebral compression fracture was not confirmed by pathology.
This study found a 20% prevalence of malignancy in our population, which is higher than other reports in the literature. Eight percent of the patients in this study were ultimately found to have a malignant aetiology behind their compression fracture, while in 18% of the cases the presumed aetiology was not confirmed on pathological examination. Compression fractures can be one of the most common manifestations of osteoporosis, but a variety of other conditions, including neoplastic processes may also be responsible. As a result, we recommend obtaining a vertebral body biopsy prior to every vertebral augmentation procedure.
经皮椎体固定术已被证实能为压缩性骨折患者缓解疼痛并恢复功能。尽管骨质疏松症很常见，但还有多种病因，如淋巴瘤、骨髓瘤或转移性疾病等也可能导致这种情况。在这些病例中，椎体活检对于确定骨折病因及协助启动同步药物治疗可能具有重要作用。
2002年至2005年期间，在我们的教学机构，对50例患者进行了80次椎体活检，同时进行经皮强化手术。其中11次活检在椎体成形术期间进行，69次在椎体后凸成形术期间进行。手术时的平均年龄为75.7岁。8例为男性，42例为女性。由一名病理学家解读所有活检样本，并查阅所有病历，检查既往病史、压缩性骨折前的诊断、活检结果以及术后出现或术后诊断出的情况。
所有患者术后压缩性骨折均愈合，且未出现并发症。11例患者在椎体骨折前被诊断为骨质疏松症，而8例患者最初怀疑其压缩性骨折是由恶性疾病引起。4例患者被确诊为恶性肿瘤，其中3例之前并无此类诊断。另外6例椎体压缩性骨折的疑似病因经病理检查未得到证实。
本研究发现我们研究人群中恶性肿瘤的患病率为20%，高于文献中的其他报道。本研究中8%的患者最终被发现其压缩性骨折背后存在恶性病因，而在18%的病例中，推测的病因经病理检查未得到证实。压缩性骨折可能是骨质疏松症最常见的表现之一，但包括肿瘤性病变在内的多种其他情况也可能导致。因此，我们建议在每次椎体强化手术前进行椎体活检。
