Guarnieri G, Ambrosanio G, Pezzullo M G, Zeccolini F, Vassallo P, Galasso R, Lavanga A, Muto M
Neuroradiology Service A.O.R.N.A. Cardarelli Hospital, Naples, Italy -
Interv Neuroradiol. 2009 Jul 29;15(2):153-7. doi: 10.1177/159101990901500203. Epub 2009 Sep 1.
This study illustrates the usefulness of vertebral biopsy in osteoporotic patients previously treated with vertebroplasty (VP) who present at follow-up with a new fracture in a vertebral soma adjacent or distant from the collapsed vertebral body. Five hundred and fifty patients with osteoporotic vertebral collapse underwent a minimally invasive treatment with vertebroplasty (VP) for a total of 980 vertebral bodies. The approach was unipedicular in 520 patients and bipedicular in 30. Only cases with unclear findings at MR or CT (23 patients) were scheduled for a vertebral biopsy before VP treatment. The biopsy results were positive for haematological disease in only eight patients. A vertebral biopsy was carried out during re-treatment with VP in all patients who presented a vertebral refracture in the three month follow-up at a site adjacent to or distant from the previously treated vertebra (21 patients). We have found new fractures of adjacent vertebrae in 15 patients and new fractures of distant vertebrae in 16 patients at three month follow-up examination. Five of the 31 cases (16%) of spinal refracture, where during vertebroplasty treatment a bone biopsy and a sternal medullary aspiration had been carried out, an anatomopathological response to multiple myeloma was responsible for the refracture. It is useful to perform a spinal bone biopsy during re-treatment of the vertebroplasty procedure to rule out multiple myeloma or other disease as the cause of the new collapse in patients with osteoporotic disease presenting a new vertebral fracture in an adjacent or distant site from the previously collapsed vertebral body.
本研究阐明了椎体活检在接受过椎体成形术（VP）治疗的骨质疏松症患者中的作用，这些患者在随访时出现了与塌陷椎体相邻或远处椎体的新骨折。550例骨质疏松性椎体塌陷患者接受了椎体成形术（VP）的微创治疗，共治疗980个椎体。520例患者采用单椎弓根入路，30例采用双椎弓根入路。仅23例在磁共振成像（MR）或计算机断层扫描（CT）检查中结果不明确的患者在VP治疗前安排了椎体活检。活检结果仅8例血液系统疾病呈阳性。所有在三个月随访时在先前治疗椎体相邻或远处部位出现椎体再骨折的患者（21例）在VP再治疗期间均进行了椎体活检。在三个月的随访检查中，我们发现15例患者出现相邻椎体新骨折，16例患者出现远处椎体新骨折。在31例椎体再骨折病例中（16%），在椎体成形术治疗期间进行了骨活检和胸骨骨髓穿刺，其中5例的再骨折是由对多发性骨髓瘤的解剖病理学反应引起的。对于在先前塌陷椎体相邻或远处部位出现新椎体骨折的骨质疏松症患者，在椎体成形术再治疗期间进行脊柱骨活检以排除多发性骨髓瘤或其他疾病作为新塌陷原因是有用的。
