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Role of Bone Biopsy During Kyphoplasty in the Setting of Known Cancer: A Case Report [Case Report]

Tariq, Muhammad B; Obedian, Richard
STUDY DESIGN/METHODS:Case report. OBJECTIVE:The aim of this study was to emphasize the utility of routine biopsy during kyphoplasty and to report on a unique case of a patient with known history of prostate cancer found to have a new metastatic cancer. SUMMARY OF BACKGROUND DATA/BACKGROUND:Vertebral compression fractures (VCFs) may cause debilitating pain with nearly one-third of them leading to chronic pain resulting in a tremendous impact on quality of life in patients. Kyphoplasty has been established as an effective means of surgical treatment. However, routine biopsy during kyphoplasty is presently not the standard of care under the presumption that most VCFs are caused by osteoporosis. The role of biopsy in the setting of known malignancy with multiple other risk factors for VCFs is not well understood. METHODS:We report on a case of a 73-year-old male with known prostate cancer presenting with persistent unremitting low back pain failing conservative management. Patient develops multiple VCFs in the course of 6 months and is treated with multiple kyphoplasties. Routine biopsy at each level is negative until the last kyphoplasty results positive for malignancy. Surprisingly, the pathology is positive for malignancy other than the patient's known prostate cancer. RESULTS:Pathology results prompt oncology workup on the patient which reveals multiple metastases and a new diagnosis of adenocarcinoma of possible upper gastrointestinal origin. In addition, patient's known prostate cancer is also noted to be active. Patient is subsequently started on chemotherapy. CONCLUSION/CONCLUSIONS:We highlight the utility of routine biopsy during kyphoplasty especially in patients with known history of malignancy. We emphasize that presumptions about the etiology of a VCF are difficult to make with multiple risk factors and that routine biopsy prevents incorrect presumptions such as in this case.Level of Evidence: 5.
PMID: 34381001
ISSN: 1528-1159
CID: 5037582

Osteochondritis dissecans of the distal femur and patella

Obedian RS; Grelsamer RP
Osteochondritis dissecans (OCD) is a pathologic process characterized by a partial or total separation of a fragment of bone with overlying articular cartilage. OCD may affect any joint, but the knee joint is affected most commonly. This article reviews several potential causes of OCD and classification systems for OCD. Diagnosis and treatment strategies are discussed
PMID: 9012566
ISSN: 0278-5919
CID: 66387

Attenuation of structural and functional damage from acute renal ischemia by the 21-amino steroid U74006F in rats

Podrazik, R M; Obedian, R S; Remick, D G; Zelenock, G B; D'Alecy, L G
PMID: 2766798
ISSN: 0149-7944
CID: 2318322