Intraoperative biopsies may be beneficial during kyphoplasty for vertebral compression fractures

NEW ORLEANS — An intraoperative biopsy of the affected spinal levels in patients who undergokyphoplasty for a vertebral compression fracture may provide “invaluable” clinical information that could impact treatment, according to investigators who presented their findings here.

During his presentation at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons, Marc A. Weinstein, MD, noted that kyphoplasty is effective for treating “potentially devastating” vertebral compression fractures.

“For us, the indication for kyphoplasty would be a patient with 2 weeks of intractable pain unresponsive to nonoperative care or any patient that we see in a hospital who is [bedridden].”

He added that orthopedic surgeons and other physicians still perform the procedure without uniform pre-, intra- and postoperative guidelines.

Study parameters

Weinstein and his colleagues studied 387 patients who underwent kyphoplasty for vertebral compression fractures between 2002 and 2007, and were treated by the senior author of the study. In addition to standard surgical procedures, each patient had an intraoperative biopsy prior to cement injection.

These patients were then included in a prospective database and followed for a mean of 48 months. The investigators evaluated the patients using the Visual Analog Scale (VAS) and the Oswestry Disability Index (ODI) at each postoperative visit.

“The standard of care”

According to Weinstein, 25 patients (8.4%) were diagnosed with an additional underlying pathology other than osteoporosis that likely contributed to the compression fracture, such as multiple myeloma, osteomyelitis or lymphoproliferative disorders. Furthermore, these patients demonstrated significantly lower VAS scores both pre- and postoperatively compared with patients who only had osteoporosis.

The investigators found patients with abnormal pathology had preoperative ODI scores that were similar to patients with normal pathology. However, they noted that patients with abnormal pathology showed a statistically significant decrease in postoperative scores compared with patients with normal pathology.

Weinstein said the lack of a uniform surgical protocol across specialties and the inconsistent procurement of biopsies at the time of surgery support the need for a multicenter prospective study that evaluates the cost benefit of intraoperative biopsies.

“Biopsies should be routinely performed in all patients who undergo vertebral cement augmentation, given our results,” he said. “To us, this would be the standard of care in our institution.”

• Reference:

Marulanda GA, Andrews SA, Bunton K, et al. Kyphoplasty for fragility fractures of the spine: The need for intraoperative biopsy. Paper #67. Presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons. March 9-13, 2010. New Orleans.

Source: OrthoSuperSite