Percutaneous biopsy evaluation in the diagnosis of thoracic and lumbar vertebral destruction syndrome

Luis Miguel Rosales-Olivares; Iván Valle-Cerna; Armando Alpizar-Aguirre; Víctor Miramontes-Martínez; María de la Luz Arenas-Sordo; Alejandro Reyes-Sánchez

2007, Number 6

<< Back Next >>

Cir Cir 2007; 75 (6)

Percutaneous biopsy evaluation in the diagnosis of thoracic and lumbar vertebral destruction syndrome

Rosales-Olivares LM, Valle-Cerna I, Alpízar-Aguirre A, Miramontes-Martínez V, Arenas-Sordo ML, Reyes-Sánchez A

Full text

How to cite this article

Language: Spanish
References: 27
Page: 459-463
PDF size: 54.36 Kb.

ABSTRACT

Background: The vertebral destruction syndrome is defined as those pathologies affecting the integrity of the vertebral structure, modifying its normal architecture and resulting in neurological deficit. Correct diagnosis is essential to define appropriate treatment. Biopsy, in addition to histopathological study, is a vital element for definitive diagnosis.
Methods: We carried out a descriptive, deliberate interventional study in 20 patients with a diagnosis of vertebral destruction in whom a percutaneous transpendicular biopsy was done between January 2005 and July 2006. Variables analyzed were age, sex, affected segment, neurological condition, neurological deficit type, results of the biopsy and specific diagnosis.
Results: There was a predominance of males (55 %). The lumbar spine was the most affected region in 80 % of patients. Of the biopsies performed, 10 % were reported as normal tissue, 20 % with degenerative changes, 15 % with inflammatory changes, 15 % with primary tumoral lesion, 5% with chronic osteomyelitis, 10 % with tuberculosis, 15 % with tumoral metastasis and 10% necrotic devitalized bone tissue. Of these patients, 55% were treated non surgically, and the remaining 45 % were treated surgically. No complications were reported.
Conclusions: Percutaneous transpedicular biopsy has only 55% specificity in diagnosis and for that reason is a less useful diagnostic method in our setting for destructive lesion diagnosisfrom the vertebral body.

REFERENCES

1. Rosales-Olivares LM. Manual de procedimientos del servicio de Cirugía de Columna Vertebral del Instituto Nacional de Rehabilitación. Agosto; 2006.
2. Ozsarlak O, De Scepper AM, Wang X, De Raeve H. CT-guided percutaneous needle biopsy in spine lesions. JBR-BTR 2003;86:294-296.
3. Ashizawa R, Ohtsuka K, Percutaneous transpedicular biopsy of thoracic and lumbar vertebrae—method and diagnostic validity. Surg Neurol 1999;52:545–551.
4. Klezl Z, Suchomelova J, Hrabal P, Klezl Z, Suchomelova J, Hrabal P. Transpedicular biopsy of thoracolumbar spine. Acta Chir Orthop Traumatol Czech 2004;71:277-280.
5. Yaffe D, Greenberg G, Leitner J, Gipstein R, Shapiro M, Bachar Gil N. CT-guided percutaneous biopsy of thoracic and lumbar spine: a new coaxial technique. AJNR Am J Neuroradiol 2003;24:2111-2113.
6. Stringham DR, Hadjipavloce A, Dzioba RB, Lander P. Percutaneous transpedicular biopsy of the spine. Spine 1994;19:1985-1991.
7. Sucu HK, Bezircioglu H, Cicek C, Ersahin Y. Computerized tomography guided percutaneous transforaminodiscal biopsy sampling of vertebral body lesions. J Neurosurg 2003;99(1 suppl):51-55.
8. Sucu HK, Cicek C, Rezanko T, Bezircioglu H, Ersahin Y, Tunakan M, Minoglu M. Percutaneous computed-tomography-guided biopsy of the spine: 229 procedures. Joint Bone Spine 2006;73:532-537 (Epub ahead of print, Mar 29).
9. Duncan GA, Ferguson AB. Benign giant-cell tumor of the fourth lumbar vertebra. A case report. Bone Joint Surg (Am) 1936;3:769-772.
10. Capener N. The evolution of lateral rachiotomy. J Bone Joint Surg (Br) 1954;36B(2):173-179.
11. Michele AA, Krueger FJ. Surgical approach to the vertebral body. J Bone Joint Surg (Am) 1949;31:873-878.
12. Travaglini F. Tumours of the vertebral body: transpedicular biopsy with posterior surgical stabilisation. Bull Hosp Joint Dis 1979;40:1-12.
13. Roy-Camille R, Saillant G, Mamoudy P. Biopsy of the vertebral body using a posterior transpedicular approach. Rev Chir Orthop 1983;69:147-149.
14. Schmidek HH, Gomes FB, Seligson D, McSherry JW. Management of acute and stable thoracolumbar with and without neurologic deficit. Neurosurgery 1980;7:30-35.
15. Fidler MW, Niers BBAM. Open transpedicular biopsy of the vertebral body. J Bone Joint Surg (Br) 1990;72:884-885.
16. Renfrew DL, Whitten CG, Wiese JA, El-Khoury GY, Harris KG. CT-guided percutaneous transpedicular biopsy of the spine. Radiol Spine J 1991;180:574-576.
17. Christodoulou A, Zidrou C, Percutaneous Harlow Wood needle biopsy of the spine: a retrospective analysis of 238 spine lesions. Orthopedics 2005;28:784-789.
18. Veillard MH, Boutry N. Contribution of percutaneous biopsy to the definite diagnosis in patients with suspected bone tumor. J Bone Joint Spine 2005;721:53-60.
19. Jelinek JS, Kransdorf MJ, Gray R. Percutaneous transpedicular biopsy. Spine 1996;21:2035-2040.
20. Kornblum MB, Wesolowski DP, Fischgrund JS, Herkowitz HN. Computed tomography-guided biopsy of the spine. A review of 103 patients. Spine 1998;23:81-85.
21. Weinstein JN. Surgical approach to spine tumors. Orthopaedics 1989;12:897-905.
22. Lis E, Bilsky MH, Pisinski L, Boland P, Healey JH, O’Malley B, Krol G. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR Am J Neuroradiol 2004;25:1583-1588.
23. Langer-Cherbit A. Value of results of radioguided deep spinal biopsy. J Radiol 1994;75:603-608.
24. Fernández-Portal L, Ortiz-Cruz YL. Ramos P. Tumores óseos primitivos y lesiones pseudotumorales de la columna vertebral. Rev Ortoped Traumatol 1996;40:614-625.
25. Gilbert RW, Kin JH, Posner JB. Epidural spinal cord compression from metastatic tumor: diagnosis and treatment. Ann Neurol 1978;3:40-51.
26. Moller S, Kothe R Fluoroscopy-guided transpedicular trocar biopsy of the spine: results, review, and technical notes. Acta Orthop Belg 2001;67:488-499.
27. Tali ET. Descripción de las características imagenológicas de las infecciones que pueden afectar la columna vertebral. Eur J Radiol 2004;50:120-133.