Our Experience with Transpedicular Vertebral Intervention for Diagnostic and Therapeutic Purposes

Abstract

Introduction: It is recommended that patients with low back and back pain not responding to conservative treatment, or who have accompanied by findings defined as 'red flag' (fever, night pain, weight loss, accompanying malignancy, etc.) should be evaluated radiologically. Transpedicular vertebral biopsy and vertebroplasty are spinal surgical procedures that have been performed for many years in patients with signs of bone collapse or infiltrative involvement, both for pathological diagnosis and treatment. Methods: CT and MRI images, clinical and pathology records of 31 cases who underwent transpedicular vertebral biopsy and vertebroplasty in our clinic between 2018-2020 were reviewed retrospectively. The procedure, procedure level and pathological diagnoses for each patient were recorded. Results: In 7 (23%) of our cases, biopsy was performed by transpedicular intervention only for the diagnosis of spondylodiscitis and for the determination of the causative agent. 24 (77%) of them had vertebral compression fractures and both diagnostic transpedicular biopsy and vertebroplasty were performed in the same session. The causative agent was detected in 3 (43%) of the patients with discitis findings (2 cases of staphylococcus aureus, 1 case of tuberculosis); in 4 (57%) the pathology and culture results were negative. While malignancy was detected in the histopathological examination of only 2 (8%) of our patients with compression fractures who underwent vertebroplasty (1 case GIS malignancy, 1 case multiple myeloma), osteoporotic compression fractures were found in the other 22 (92%) cases. In only one of the cases who underwent vertebroplasty, operation was performed at 2 levels (L1 and L2). Other levels were L1 (10 cases), L3 (5 cases), T11 (3 cases), L2 (2 cases), T9 (1 case), T12 (1 case) and L5 (1 case), respectively. Discussion and Conclusion: Transpedicular vertebral biopsy can be safely performed in the detection of causative agent and pathological diagnosis of vertebral corpus lesions and infections. Vertebroplasty is an effective and reliable method for both pain control and increasing the stability of the vertebra in patients with pain due to osteoporotic bone collapse or metastatic vertebral involvement.