Rate of Unexpected Malignancy in Patients Undergoing Percutaneous Vertebroplasty after Implementing a New Scanning Protocol.

STUDY DESIGN: Retrospective quality improvement study.

OBJECTIVE: To investigate if the rate of unsuspected malignancy in biopsies in patients with VCF who underwent PVP at the same orthopedic department has changed after implementation of a new MRI scanning protocol.

SUMMARY OF BACKGROUND DATA: Discrimination between benign and malign vertebral compression fracture (VCF) can be difficult. However, early diagnosis of malignant VCF is crucial to further treatment and prognosis. An earlier study at an orthopedic department reported a rate of unsuspected malignancy of 4.9% in patients with VCF who underwent percutaneous vertebroplasty (PVP) when biopsies were obtained during the procedure. MRI scanning protocol was changed in this period.

METHODS: Retrospective on 427 patients with vertebral compression fracture undergoing PVP from 28th of April 2017 to 28th of April 2022, identifying operated patients from the Danish national DaneSpine registry. Subsequently, individual clinical information was collected in journal records.

RESULTS: The rate of unsuspected malignancy was 0.9% (4/427) and the overestimation of malignant VCF was 50% (16/32).

CONCLUSION: During the last 5 years, the rate of unsuspected malignancy in patients with VCF undergoing PVP has improved considerably from 4.9% to 0.9%. Furthermore, MRI is over-diagnosing malignancies. Thus, the new scanning procedure is effective in differentiating between benign and malign VCFs.

LEVEL OF EVIDENCE: 3.