Abstract
Objective
Kyphoplasty and vertebroplasty have become one of the most frequent surgical procedures in the treatment of vertebral compression fractures. Often, the cause of compression fractures is lowered bone mineral density as in osteoporosis. In the differential workup, also pathologic vertebral compression fractures need to be ruled out. Importantly, imaging techniques alone cannot safely differentiate between invasive lymphatic and osteoporotic vertebral fracture. Our goal was to identify the degree of unexpected positive histology in kyphoplasty for presumed osteoporotic vertebral compression fracture.
Methods
We retrospectively analyzed all kyphoplasties performed between 2007 and 2015 at our institution. The data were acquired by reviewing our medical documentation system. The data analysis was done using Microsoft Excel. The statistical analysis was done using the Chi-squared test.
Results
We performed 130 kyphoplasties/vertebroplasties. A biopsy was taken in 97 (74.6%) cases. In 10 (10.3%) cases, the histology revealed a pathological fracture. From these patients, only in 3 (30%) cases, a positive histology was not expected. Meaning that there was no history of cancer and the radiological findings presumed an osteoporotic fracture.
Conclusions
Therefore, we could demonstrate that the incidence of unexpected positive histology in vertebral compression fracture treated with kyphoplasty is significant (3.1%). As a conclusion, if a kyphoplasty is performed due to assumed osteoporotic vertebral compression fracture, a biopsy should be taken to safely rule out a pathological fracture caused by lymphatic bony invasion.
Similar content being viewed by others
References
Abrego G, García J, Gilbert B, Forseen S, Toscano M (2016) ALK positive anaplastic large cell lymphoma of the thoracic spine. J Radiol Case Rep 10(9):1–12
Bhat AR, Kirmani AR, Wani MA, Bhat MH (2016) Incidence, histopathology, and surgical outcome of tumors of spinal cord, nerve roots, meninges, and vertebral column—data based on single institutional (Sher-i-Kashmir Institute of Medical Sciences) experience. J Neurosci Rural Pract 7(3):381–391
Godersky JC, Smoker WRK, Knutzon R (1987) Use of MRI in the evaluation of metastatic spinal disease. Neurosurgery 21:676–680
Keating MJ, O’Brien S, Lerner S, Koller C, Beran M, Robertson LE et al (1998) Long-term follow-up of patients with chronic lymphocytic leukemia (CLL) receiving fludarabine regimens as initial therapy. Blood 92:1165–1171
Lips P (1997) Epidemiology and predictors of fractures associated with osteoporosis. Am J Med 103(2A):3S–8S
Taylor RS, Taylor RJ, Fritzell P (2006) Balloon kyphoplasty and vertebroplasty for vertebral compression fractures: a comparative systematic review of efficacy and safety. Spine 31(23):2747–2755
Zhang L, Wang Q, Wang L, Shen J, Zhang Q, Sun C (2017) Bone cement distribution in the vertebral body affects chances of recompression after percutaneous vertebroplasty treatment in elderly patients with osteoporotic vertebral compression fractures. Clin Interv Aging 12:431–436
Hansen EJ, Simony A, Carreon L, Andersen MO (2016) Rate of unsuspected malignancy in patients with vertebral compression fracture undergoing percutaneous vertebroplasty. Spine (Phila Pa 1976) 41(6):549–552
Deb P, Malik A, Sinha KK (2011) Intraoperative scrape cytology: adult granulosa cell tumor of ovary. J Cytol 28(4):207–209
Naresh-Babu J, Neelima G, Reshma-Begum SK (2014) Increasing the specimen adequacy of transpedicular vertebral body biopsies. Role of intraoperative scrape cytology. Spine J 14:2320–2325
Inuganti RV, Mettu RR, Surath HV, Surath A (2016) The role of intraoperative scrape cytology in vertebroplasty. Cytojournal 13:11
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no competing interests.
Rights and permissions
About this article
Cite this article
Nowak, S., Müller, J., Schroeder, H.W.S. et al. Incidence of unexpected positive histology in kyphoplasty. Eur Spine J 27, 847–850 (2018). https://doi.org/10.1007/s00586-017-5458-z
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-017-5458-z