Routine needle biopsy during vertebral augmentation procedures. Is it necessary?

Vertebral augmentation procedures are currently widely performed to treat vertebral compression fractures. The purpose of this study was to determine the frequency of underlying previously unrecognized etiology in a consecutive series of patients undergoing kyphoplasty to treat vertebral compression fractures. A prospective histological evaluation of vertebral body biopsy specimens from presumed osteoporotic vertebral compression fractures were performed in order to identify aforementioned causes. Over a 2-year period, vertebral body biopsies from 154 vertebral levels were performed in 75 patients undergoing kyphoplasty for vertebral compression fractures. All patients received a preoperative workup that included plain radiographs, MRI, whole body bone scan, and laboratory examinations. Bone specimens were obtained from affected vertebral bodies and submitted for histologic evaluation to identify the prevalence of an underlying cause. All specimens demonstrated fragmented bone with variable amounts of unmineralised bone, signs of bone-remodeling and/or fracture-healing. In 11 patients underlying pathology other than osteoporosis was identified (prostate cancer, 1; pancreatic cancer, 1; colon cancer, 1; breast cancer, 2; multiple myeloma, 3; leukemia, 1; and lung cancer, 2). In all but one patient the results of the biopsy confirmed the diagnosis suspected from the preoperative workup. For the last patient, namely the one with pancreatic cancer, the workup did not identify the origin of the primary tumor, although the patient was considered to have a compression fracture secondary to metastatic disease of unknown origin, the vertebral biopsy suggested the presence of adenocarcinoma which eventually was proven to be pancreatic cancer. In augmentation procedures for vertebral compression fractures, bone biopsy should be reserved for the patients where the preoperative evaluation raises the suspicion of a non-osteoporotic etiology.     

Retrospective review of biopsy results following percutaneous fixation of vertebral compression fractures

BACKGROUND: 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. MATERIALS AND METHODS: 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. RESULTS: 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. DISCUSSION: 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.     

椎体后凸成形术治疗椎体压缩性骨折中穿刺活检的价值

目的评价椎体压缩性骨折患者行椎体后凸成形术（PKP）时,穿刺活检测定未预料的恶性肿瘤的发生率。方法回顾性分析我院PKP术中穿刺所得的活检样本,2003年1月至2010年7月行PKP治疗椎体压缩性骨折患者216例,男60例,女156例,年龄36～92岁,平均68.4岁。其中有恶性疾病病史者9例,术中共取活检标本249个,由资深病理科医师对标本进行评价。结合患者病史、术前术后症状、病理结果及影像学资料综合分析。结果所有患者压缩性骨折获得治愈,疼痛缓解,症状消失,未出现有症状的并发症。204例病理结果符合压缩性骨折的诊断,表明了骨折愈合的不同阶段。9例有恶性疾病病史患者中,6例确诊为转移性肿瘤,3例活检时未发现恶性病变。另3例患者之前未诊断为恶性疾病病理结果显示恶性。结论 PKP术中常规取活检并不会增加手术风险,但能证实潜在的压缩性骨折的病理过程。本研究中未预料到的恶性肿瘤发生率为1.4%,我们推荐在PKP治疗椎体压缩性骨折中常规取病理活检。     

Aspiration of osteoprogenitor cells for augmenting spinal fusion: comparison of progenitor cell concentrations from the vertebral body and iliac crest

BACKGROUND: Successful arthrodesis in challenging clinical scenarios is facilitated when the site is augmented with autograft bone. The iliac crest has long been the preferred source of autograft material, but graft harvest is associated with frequent complications and pain. Connective tissue progenitor cells aspirated from the iliac crest and concentrated with allograft matrix and demineralized bone matrix provide a promising alternative to traditional autograft harvest. The vertebral body, an even larger reservoir of myeloproliferative cells, should provide progenitor cell concentrations similar to those of the iliac crest. METHODS: Twenty-one adults (eleven men and ten women with a mean age of 59 +/- 14 years) undergoing posterior lumbar arthrodesis and pedicle screw instrumentation underwent transpedicular aspiration of connective tissue progenitor cells. Aspirates were obtained from two depths within the vertebral body and were quantified relative to matched, bilateral aspirates from the iliac crest that were obtained from the same patient at the same time. Histochemical analysis was used to determine the prevalence of vertebral progenitor cells relative to the depth of aspiration, the vertebral level, age, and gender, as compared with the iliac crest standard. The cell count, progenitor cell concentration (cells/cc marrow), and progenitor cell prevalence (cells/million cells) were calculated. RESULTS: Aspirates of vertebral marrow demonstrated comparable or greater concentrations of progenitor cells compared with matched controls from the iliac crest. Progenitor cell concentrations were consistently higher than matched controls from the iliac crest (p = 0.05). The concentration of osteogenic progenitor cells was, on the average, 71% higher in the vertebral aspirates than in the paired iliac crest samples (p = 0.05). With the numbers available, there were no significant differences relative to vertebral body level, the side aspirated, the depth of aspiration, or gender. An age-related decline in cellularity was suggested for the iliac crest aspirates. CONCLUSIONS: The vertebral body is a suitable site for aspiration of bone marrow for graft augmentation during spinal arthrodesis.     

Combined percutaneous transpedicular tumor debulking and kyphoplasty for pathological compression fractures. Technical note

Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation. The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case. A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.     

Vertebroplasty and Kyphoplasty in Spinal Trauma

Abstract Kyphoplasty and vertebroplasty have become recognized procedures for the treatment of vertebral fractures, especially in patients with osteoporosis. In most cases of osteoporotic spinal vertebral fracture in elderly patients, polymethylmethacrylate (PMMA) cement is used to fill the defect and stabilize the vertebral body. The techniques of vertebroplasty and kyphoplasty differ in the possibility of realignment and reconstruction of the vertebral body and spinal column. Long-term results in terms of integration of the cement and bioreactivity of the vertebral body are still lacking; so, these procedures are still no options in the treatment of younger patients. Vertebroplasty and kyphoplasty show different success in the management of fresh traumatic spine fractures. The acute traumatic vertebral fracture has to be classified sensitively, to find the right indication for cement augmentation. Mild acute compression fractures can be treated by vertebroplasty or kyphoplasty, severe compression and burst fractures by combination of internal fixation and kyphoplasty. The indications for use of biological or osteoinductive cement in spinal fracture management must still be regarded as restricted owing to the lack of basic biomechanical research data. Such cement should not be used except in clinical studies.     

Evolution of bone mineral density after percutaneous kyphoplasty in fresh osteoporotic vertebral body fractures and adjacent vertebrae along with sagittal spine alignment

STUDY DESIGN: Prospective controlled cohort study of 27 adult osteoporotic patients who underwent kyphoplasty for fresh osteoporotic spinal fractures. OBJECTIVES: To define the evolution of vertebral bone mineral density (BMD) at kyphoplasty and adjacent levels along with sagittal spinal alignment to contribute to the etiology of adjacent vertebral fractures after augmentation. SUMMARY OF BACKGROUND DATA: Osteoporotic compression fractures can be effectively treated with methylmethacrylate vertebral augmentation. However, to the authors' knowledge the effect of vertebral augmentation on the vertebral endplate BMD of the augmented and adjacent nonaugmented levels has not as yet been described. METHODS: Twenty-seven consecutive selected patients (9 men, 18 women), with an average age of 72+/-9 years underwent 1, 2, or 3-level percutaneous kyphoplasty for painful fresh osteoporotic vertebral fractures at the thoracolumbar spine. All patients were radiologically examined with plain roentgenograms, computed tomography, and magnetic resonance imaging. Lateral dual energy x-ray absorptiometry in the augmented and on the adjacent vertebrae (1 level above and below kyphoplasty) was used to measure BMD preoperatively to the last postoperative observation in the subchondral bone of the vertebral endplates. Anthropometric data, sagittal global balance (plumbline), and segmental spine reconstruction (vertebral body height, Gardner kyphotic angle) were recorded and analyzed. The patients were followed for at least 2 years. RESULTS: Kyphoplasty was performed between T12 and L5. A total of 48 vertebral bodies were augmented. Thirteen patients received 1 level and the remaining 14 received 2 or 3-level kyphoplasty. No significant changes in the sagittal spinal balance were shown postoperatively. Gardner kyphotic angle and posterior vertebral body height improved postoperatively, however, insignificantly. Significant [analysis of variance (ANOVA), P=0.008] increase of anterior vertebral body height in the fractured vertebra was achieved postoperatively without subsequent loss of correction. BMD increased significantly in the lower endplate of the augmented vertebra (ANOVA, P=0.05). In 1-level augmentation, no BMD changes were shown at the adjacent vertebrae above and below kyphoplasty. On the contrary, in the multilevel augmentation, a statistically significant (ANOVA, P=0.05) decrease of the BMD was shown in the upper endplate of the adjacent level above kyphoplasty. During the 2-year follow-up, there were 5 (18%) new fractures at the T11-T12 area above the augmented vertebra. All of the fractures occurred in patients who received 2 and 3-level kyphoplasty. CONCLUSIONS: The observed 2-year evolution of vertebral endplate BMD, after kyphoplasty under stable global sagittal spinal balance, might contribute to the pathogenesis of new fractures in adjacent vertebra. However, other studies with control series and longer follow-up are necessary to show if these BMD changes are the result of vertebral augmentation or are merely natural history.     

Vertebroplasty and kyphoplasty update

Vertebroplasty and kyphoplasty are minimally invasive vertebral augmentation procedures in which a filler material is percutaneously injected into a vertebral body for the treatment of vertebral fractures associated with osteoporosis, malignant conditions, hemangiomas, and osteonecrosis. In vertebroplasty, the filler is injected directly into the bone, whereas in kyphoplasty, the filler is injected into a cavity created by inflation of a balloon tamp. The goals of treatment include pain relief, fracture stabilization, restoration of vertebral height, and strengthening of the vertebral body to reduce the risk of a future fracture at the same level. When performed by a well-trained physician in appropriately selected patients, vertebral augmentation is usually effective in achieving one or more of these goals, with a generally good short-term safety profile. Although these procedures hold great promise in the management of vertebral fractures, many questions about long-term efficacy and safety remain.     

Kyphoplastik im konventionellen und halboffenen Verfahren

Kyphoplasty is a young method which was developed for the minimally invasive augmentation of osteoporotic vertebral fractures. In contrast to vertebroplasty, the kyphoplasty technique allows an age-dependent fracture reduction through the inflation of a special balloon in the fractured cancellous bone of the vertebral body. The cancellous bone of the fracture zone is compressed by the balloon, so that a cavity remains in the vertebral body after removing the balloon, which is filled with highly viscous augmentation material. The reduced risk of serious complications, for example epidural leakage of augmentation material, justifies progressively expanding the indications for this technique to traumatic fractures with involvement of the posterior vertebral wall and neoplastic vertebral collapse due to osteolytic metastasis. Besides the indications for the conventional percutaneous approaches, the microsurgical interlaminary approach allows the use of kyphoplasty in more complex fractures involving compression of the neural structures. Kyphoplasty induces swift pain relief and allows rapid mobilisation of patients due to the immediate stabilisation of the affected vertebral bodies. Apart from the operative intervention, the medical treatment of the primary disease and the rehabilitation of the individual patient should be optimised through an interdisciplinary approach.     

气囊扩张椎体后凸成形术的初步报告

目的:初步评价气囊扩张后突成形术治疗骨质疏松性椎体压缩骨折的手术操作、安全性、及疗效。方法:观察21例骨质疏松患者,30节椎体,新鲜骨折24椎节,陈旧性骨折6椎节,均有局部腰背疼痛,无神经症状。C-arm透视下,两侧同时经皮穿刺,气囊扩张骨折复位后,骨水泥灌注入椎体。随访4～7月。记录患者局部止痛的疗效,骨折的复位,及并发症等情况。结果:完全止痛14例,部分止痛7例,24节新鲜骨折气囊扩张的复位率是28.2％,6节陈旧性骨折复位率是2.1％。并发症2例,骨水泥外漏到椎间隙。其他椎体再次骨折2例,余无疼痛复发及椎体高度丢失。结论:气囊扩张后突成形术能恢复脊柱的稳定性,部分矫正脊柱后突,止痛疗效好,创伤小,并发症少,值得推广。     

Transpedicular aspiration of osteoprogenitor cells from the vertebral body: progenitor cell concentrations affected by serial aspiration

Background contextSpinal fusion is facilitated when the fusion site is augmented with autograft bone. Iliac crest, long the preferred source of autograft material, is the site of frequent complications and pain. Connective tissue progenitor cells (CTPs) aspirated from marrow provide a promising alternative to traditional autograft harvest. The vertebral body represents an even larger potential reservoir of progenitor cells than the ilium.PurposeTo test the hypothesis that a suitable concentration of osteoprogenitor cells can be aspirated from different depths of the vertebral body, maintaining progenitor cell concentrations comparable to the “gold standard,” the iliac crest, even after sequential aspirations along the same transpedicular axis.Study designProspective clinical investigation quantifying CTP concentrations within the vertebral body relative to depth of sequential aspirations.Patient sampleAdult men and women undergoing elective posterior lumbar fusion and pedicle screw instrumentation (six men and seven women, mean age 56 years [range 40–74 years]).Outcome measuresCell count, CTP concentration (CTPs/cc marrow), and CTP prevalence (CTPs/million cells) were calculated for both individual and pooled aspirate samples.MethodsThirteen patients were enrolled into an institutional review board–approved protocol studying transpedicular aspiration of marrow progenitor cells. Connective tissue progenitor cells were aspirated from four depths along the transpedicular axis of the vertebral body and quantified according to cell concentration and CTP prevalence. Histochemical analysis of alkaline phosphatase–positive colony-forming units (CFUs) provided the prevalence of vertebral CTPs relative to depth of aspiration, vertebral level, age, and gender.ResultsFour 2.0 cc aspirations were obtained from each pedicle of lumbar vertebrae selected for pedicle screw fixation (four 2.0 cc aspirates from each of four pedicles). Aspirates of vertebral marrow demonstrated comparable or greater concentrations of CFUs compared with standards previously established for the iliac crest. Overall, the 208 aspirations from 26 vertebral bodies provided a mean CTP concentration of 741.5±976.2 CTPs per cubic centimeter of marrow, ranging from a mean concentration of 1316±1473 CTPs per cubic centimeter of marrow at superficial (30 mm) aspirations to 439±557 CTPs per cubic centimeter marrow at deepest (45 mm) aspiration depths (p<.00002). There were no significant differences relative to vertebral body level, side aspirated, or gender. An age-related decline in cellularity was suggested for vertebral body aspirates.ConclusionsThe vertebral body is a potential marrow reservoir for aspiration of autograft osteogenic CTPs that can be used to augment spinal fusion. The cancellous bone within that portion of the vertebral body routinely cannulated during pedicle screw placement allows serial aspirations with only modest depletion of progenitor cell concentrations or dilution with peripheral blood. Connective tissue progenitor cell concentrations from all depths were comparable to the mean levels previously established for the iliac crest. The ability to simultaneously harvest progenitor cells for graft augmentation while preparing the pilot hole for pedicle screw fixation will expand the potential for cell harvest techniques for fusion augmentation and reduce the need for iliac crest harvest.     

Balloon kyphoplasty in the therapy of vertebral fractures

Approximately 500,000 vertebral fractures occur as a result of osteoporosis every year in Europe. One third of the patients thus affected complain of severe back pain and seek treatment. In the past, the treatment of such fractures was limited to conservative methods, such as the use of braces and analgesics and long-term immobilisation followed by physiotherapy. Since 1998 balloon kyphoplasty, a minimally invasive procedure, has also been available for their treatment. During balloon kyphoplasty a balloon system is introduced into a fractured vertebral body to achieve bitranspedicular augmentation, after which low-viscosity bone cement is injected into the vertebral body, where it sets very quickly. In general the patient can be fully mobilized 24-48 h after the procedure and in most cases the symptoms are then considerably attenuated; many patients are actually free of pain. Published studies and our own experience indicate that balloon kyphoplasty is a safe method of treating painful vertebral compression fractures sustained in various ways and that complications are rare with this procedure.     

Balloon kyphoplasty in the treatment of vertebral fractures

Approximately 500,000 vertebral fractures occur as a result of osteoporosis every year in Europe. One third of the patients thus affected complain of severe back pain and seek treatment. In the past, the treatment of such fractures was limited to conservative methods, such as the use of braces and analgesics and long-term immobilisation followed by physiotherapy. Since 1998 balloon kyphoplasty, a minimally invasive procedure, has also been available for their treatment. During balloon kyphoplasty a balloon system is introduced into the fractured vertebral body to achieve bitranspedicular augmentation, after which low-viscosity bone cement is injected into the vertebral body, where it sets very quickly. In general the patient can be fully mobilized 24-48 h after the procedure and in most cases the symptoms are then considerably attenuated; many patients are actually free of pain. Published studies and our own experience indicate that balloon kyphoplasty is a safe method of treating painful vertebral compression fractures sustained in various ways and that complications are rare with this procedure.     

Ballonkyphoplastie in der Therapie von Wirbelkörperfrakturen

Approximately 500,000 vertebral fractures occur as a result of osteoporosis every year in Europe. One third of the patients thus affected complain of severe back pain and seek treatment. In the past, the treatment of such fractures was limited to conservative methods, such as the use of braces and analgesics and long-term immobilisation followed by physiotherapy. Since 1998 balloon kyphoplasty, a minimally invasive procedure, has also been available for their treatment. During balloon kyphoplasty a balloon system is introduced into the fractured vertebral body to achieve bitranspedicular augmentation, after which low-viscosity bone cement is injected into the vertebral body, where it sets very quickly. In general the patient can be fully mobilized 24–48 h after the procedure and in most cases the symptoms are then considerably attenuated; many patients are actually free of pain. Published studies and our own experience indicate that balloon kyphoplasty is a safe method of treating painful vertebral compression fractures sustained in various ways and that complications are rare with this procedure.     

An unconventional indication for open kyphoplasty

BACKGROUND CONTEXT: Kyphoplasty is a means of treatment for painful osteoporotic vertebral body compression fractures. Its efficacy has not yet been totally proven. Even though the conventional percutaneous kyphoplasty is a relatively safe procedure, it is not routinely recommended for use in vertebral body fractures that involve posterior cortical compromise/retropulsion or in fractures associated with neurological deficit. PURPOSE: To see whether the open kyphoplasty procedure can be used in patients with painful vertebral body compression fractures who also have bony retropulsion into the spinal canal. STUDY DESIGN/SETTING: This technical report is based on the experience of one patient. METHODS: A 79-year-old woman with a history of osteoporosis presented with a painful vertebral body compression fracture at T12. Magnetic resonance imaging of her lumbar spine demonstrated an acute compression fracture at T12 with significant decrease in vertebral body height and retropulsion of bone resulting in one-third reduction in canal width. She was not considered a candidate for percutaneous kyphoplasty. Three months after the injury, an open kyphoplasty was performed after a decompression laminectomy at T12. RESULTS: The fractured vertebral body was successfully reduced, and there was no leakage of polymethylmethacrylate into the spinal canal through the fractured posterior cortex using the open kyphoplasty procedure. One month after the operation, the patient was free from mid-back pain and was again able to walk. CONCLUSION: Open kyphoplasty procedure allows direct visualization to the spinal canal. It can be performed safely and effectively in selected vertebral body compression fractures with retropulsed bone associated with neurological deficit.     

Initial outcome and efficacy of "kyphoplasty" in the treatment of painful osteoporotic vertebral compression fractures.

STUDY DESIGN: An Institutional Review Board-approved Phase I efficacy study of inflatable bone tamp usage in the treatment of symptomatic osteoporotic compression fractures. OBJECTIVES: To evaluate the safety and efficacy of inflatable bone tamp reduction and cement augmentation, "kyphoplasty," in the treatment of painful osteoporotic vertebral compression fractures. SUMMARY OF BACKGROUND DATA: Osteoporotic compression fractures can result in progressive kyphosis and chronic pain. Traditional treatment for these patients includes bed rest, analgesics, and bracing. Augmentation of vertebral compression fractures with polymethylmethacrylate, "vertebroplasty," has been used to treat pain. This technique, however, makes no attempt to restore the height of the collapsed vertebral body. Kyphoplasty is a new technique that involves the introduction of inflatable bone tamps into the vertebral body. Once inflated, the bone tamps restore the vertebral body back toward its original height while creating a cavity that can be filled with bone cement. PATIENTS AND METHODS: Seventy consecutive kyphoplasty procedures were performed in 30 patients. The indications included painful primary or secondary osteoporotic vertebral compression fractures. Mean duration of symptoms was 5.9 months. Symptomatic levels were identified by correlating the clinical data with MRI findings. Perioperative variables and bone tamp complications or issues were recorded and analyzed. Preoperative and postoperative radiographs were compared to calculate the percentage height restored. Outcome data were obtained by comparing preoperative and latest postoperative SF-36 data. RESULTS: At the completion of the Phase I study there were no major complications related directly to use of this technique or use of the inflatable bone tamp. In 70% of the vertebral bodies kyphoplasty restored 47% of the lost height. Cement leakage occurred at six levels (8.6%).SF-36 scores for Bodily Pain 11.6-58.7, (P = 0.0001) and Physical Function 11.7-47.4, (P = 0.002) were among those that showed significant improvement. CONCLUSIONS: The inflatable bone tamp was efficacious in the treatment of osteoporotic vertebral compression fractures. Kyphoplasty is associated with early clinical improvement of pain and function as well as restoration of vertebral body height in the treatment of painful osteoporotic compression fractures.     

Iliac crest biopsy versus rib segment resection for the detection of bone marrow isolated tumor cells from lung and esophageal cancer.

OBJECTIVE: The presence of isolated tumor cells in the bone marrow affects the prognosis of both esophageal cancer and non-small cell lung cancer (NSCLC). Therefore, preoperative assessment of isolated tumor cells may be useful to plan multimodality treatment. Rib segment resection at surgery provides adequate amounts of bone marrow for the detection of isolated tumor cells while bone marrow aspirate from the iliac crest does not. The iliac crest biopsy according to the Jamshidi technique procures a core of tissue apt for histology and not simply for cytology. The aim of this study was to compare the accuracy of iliac crest biopsy versus rib segment resection in the diagnosis of isolated tumor cells in order to obtain a useful preoperative approach. MATERIAL AND METHODS: Twenty-one consecutive patients (18 NSCLC, three esophageal cancer) were evaluated. None had chemotherapy prior to evaluation. Bone marrow was obtained preoperatively by iliac crest biopsy using the Jamshidi needle and at surgery by rib segment resection. Positive cytokeratin neoplastic cells were searched by immunohistochemistry on tissue sections from the iliac crest biopsies and by flow cytometry on cell suspensions from the rib segments. RESULTS: Isolated tumor cells were detected in the rib segments of ten patients. In all cases the Jamshidi needle biopsy was not diagnostic. CONCLUSION: Our results suggest that, if the diagnosis of bone marrow isolated tumor cells has clinical relevance, the preoperative assessment should be performed by rib segment resection or methods other than iliac crest aspirate or biopsy. Further investigation is needed to determine whether isolated tumor cells have a preferential spread to chest bones other than distant bone sites.     

Vertebroplasty and kyphoplasty for the management of osteoporotic vertebral compression fractures

Osteoporotic vertebral compression fractures have previously been treated nonoperatively given the tremendous morbidity associated with open fixation in elderly patients who often have multiple medical comorbidities. With the advent of percutaneous vertebral augmentation techniques, these fractures can now be stabilized using minimally invasive surgical techniques while maintaining a relatively safe risk profile. Vertebroplasty and kyphoplasty provide immediate pain relief in the great majority of patients who have painful, osteoporotic vertebral compression fractures. The balloon used in kyphoplasty may allow for improved height restoration, cavity creation, and decreased cement extravasation rates. The authors discuss the procedural steps, advantages and disadvantages, and results of each technique, recognizing that prospective, randomized controlled studies are necessary to objectively compare the two techniques.     

The role of percutaneous vertebral augmentation in patients with metastatic breast cancer: Literature review including report of two cases

Patients with metastatic breast cancer are at high risk for developing vertebral compression fractures due to underlying bone metastases and bone density loss. Vertebral augmentation techniques including percutaneous vertebroplasty and percutaneous balloon kyphoplasty are techniques used to stabilize compression fractures and improve pain. However, rare complications from these interventions have been observed, including spinal cord compression, nerve root compression, venous cement embolism, and pulmonary cement embolism. These complications pose unique potential challenges for patients with cancer who may already have decreased lung function and potential for venous thromboembolism. In this review, we first describe the role of percutaneous vertebral augmentations in patients with metastatic cancer, with a particular focus on patients with breast cancer. Then, we describe complications of vertebral augmentation in two patients with metastatic breast cancer including long-term symptomatic and radiographic follow-up.     

椎体后凸成形术后椎体再骨折相关因素分析研究

背景：椎体后凸成形术（percutaneous kyphoplasty,PKP）治疗骨质疏松性椎体压缩骨折取得了令人鼓舞的临床效果,但是术后椎体发生再骨折时有报道,越来越引起l临床医生的重视。目的：探讨PKP治疗骨质疏松性椎体压缩骨折术后出现椎体再骨折的相关危险因素。方法：回顾性分析209例因骨质疏松性椎体压缩骨折而接受PKP手术治疗患者的相关临床资料,其中男43例,女166例,年龄51～88岁,平均73．0岁。所有患者术后随访时间均为1年以上,根据术后是否出现椎体再骨折分为再骨折组（42例）和对照组（167例）,比较两组患者的相关临床资料,分析椎体再骨折的可能危险因素。结果：两组患者在年龄、性别、身高、体重、平均单椎体骨水泥注入量、术后椎体高度压缩率等方面无统计学差异（P〉0．05）,但是两组患者的骨水泥椎间盘渗漏率和术前骨密度存在统计学差异（P〈O．05）。结论：骨水泥椎间盘渗漏和骨质疏松严重程度可能是骨质疏松性椎体压缩骨折PKP术后椎体再骨折的危险因素。