Value the importance of routine biopsy during vertebral augmentation: a prospective observational study of one...

Osteoporotic vertebral compression fractures (OVCFs) are highly prevalent among the elderly. However, spinal metastases can also lead to pathological fractures that are often misdiagnosed as OVCFs. This study aimed to determine the prevalence of unsuspected malignant vertebral compression fractures (VCFs) among patients initially suspected to have OVCFs.

From October 2020 to December 2023, 141 patients with suspected OVCFs underwent routine vertebral biopsy during percutaneous kyphoplasty (PKP) at our institution. All patients received standardized treatment and prospective clinical data collection. Follow-up questionnaires were completed in person or via telephone.

A total of 168 biopsy specimens were obtained from 141 patients, and all samples (100%) were successfully evaluated histopathologically. Unexpected spinal metastases were identified in six patients (4.3%). Of the 19 patients with a known history of malignancy but without characteristic radiographic features of pathological fracture, only two cases (10.5%) were confirmed as metastatic involvement from the primary cancer. Among the remaining 112 patients without a cancer history, four unexpected malignancies were identified (one lymphoma and three lung cancers). The overall prevalence of unsuspected malignant VCFs in this cohort was 4.3%.

Given the observed prevalence of unsuspected malignant VCFs, we recommend that routine vertebral biopsy be performed during every PKP procedure for patients with OVCFs to ensure early detection of occult malignancy.