2024, Number 1
Evaluation of fluoroscopy-guided percutaneous biopsy as an auxiliary in the diagnosis of post COVID-19 pandemic vertebral destruction syndrome in a medical center of third level of reference
Contreras ZMF, González MA, Guzmán CJE, Sotelo MIJ
Full text
10.35366/114908
Language: Spanish
References: 25
Page: 19-25
PDF size: 223.76 Kb.
ABSTRACT
Introduction: many conditions of the musculoskeletal system manifest as focal abnormalities, the vertebral body being a common site of injury. Vertebral destruction syndrome is defined as the set of pathologies that affect the structural integrity and modify the normal architecture of the vertebra, producing spinal instability and neurological deficit. It is a pathology with multiple etiology characterized by alterations of the structure and ultrastructure in the bone of the vertebral column; It is accompanied by pain and functional disability due to mechanical and neurological alterations. Its causes can be infectious: bacteria, mycobacteria, fungi and parasites; primary tumors: benign and malignant; tumor metastasis and metabolic diseases: osteoporosis, osteomalacia, Paget's disease, among others. The diagnosis of this syndrome is related to clinical data, laboratory studies and cabinet. Magnetic resonance imaging, computed tomography, fluoroscopy, and scintigraphy provide means for this. Another vital element is the biopsy of the vertebral body; since the precise diagnosis is essential to define the opportune and adequate treatment. The spine is the third most common site for the presentation of osteomyelitis. The etiology is due to any condition that causes bacteremia; the most common source is urinary tract infections. Bacteriologically, at the beginning of the 20th century, staphylococcus aureus was almost exclusively reported as a pathogen; currently, other types of microorganisms have been isolated, such as Gram negatives, Escherichia coli, Pseudomonas and Proteus. Neoplasms can originate from local lesions that develop within or adjacent to the vertebral column or from distant neoplasms. The incidence of primary spinal neoplasms is 2.5 to 8.5 per 100,000 people per year. Metastatic tumors are by far the most common; between 5 and 30% of all cancer patients have had spinal metastases, predominantly those derived from breast, lung, prostate, or lymphoreticular disease. Bone lesions can only be seen until there is 30 to 50% trabecular destruction. The definitive diagnosis of these pathologies is only possible by biopsy. Open biopsy maximizes and ensures tissue obtaining; however, imaging-guided percutaneous transpedicular biopsy has been shown to be very safe and can be performed at all levels of the spine. Thus, biopsies are divided into two types: open and closed, percutaneous or puncture. A large number of biopsies are still open, since they are continues to consider the election procedure. Depending on the instrumentation used and the type of sample obtained, percutaneous biopsy is divided into fine needle aspiration (FNAB) and tissue cylinder. Objective: to assess the usefulness of percutaneous transpedicular biopsy guided by Fluroscopy in conjunction with the systematization of studies as diagnostic tests of the etiology of vertebral destruction post-COVID-19 pandemic. Material and methods: prospective cross-sectional case series study with non-probabilistic sampling type of consecutive cases of a universe of subjects with a diagnosis of vertebral destruction syndrome in the period from November 1, 2021 to July 15, 2022 whose sample was 20 patients. The people studied were of both genders, over 18 years of age, with a complete vertebral destruction protocol and who had signed the informed consent; those previously diagnosed and those who had some pathology that prevented them from being in a prone position for taking the biopsy were not included, and those who refused to perform the procedure were excluded. Results: the male sex predominated with 55%. The lumbar spine was the most affected in 80%; 10% of the biopsies were reported as normal tissue, 20% with degenerative changes, 15% with inflammatory changes, 15% with primary tumor lesion, 5% with chronic osteomyelitis, 10% with tuberculosis, 15% with tumor metastasis, and in 10% necrotic devitalized bone tissue; in 2 cases, clinical correlation was performed between biopsy and systematization of studies to obtain the diagnosis. Conclusions: percutaneous transpedicular biopsy guided by fluoroscopy is a simple, useful, reliable, low-cost, and effective technique; in the study of destructive lesions of the spinal column.REFERENCES