Image Guided Percutaneous Transpedicular Spinal Biopsy

Background: The presence of a spinal lesion presents a diagnostic challenge as many times clinico-radiological diagnosis differs from tissue diagnosis. Percutaneous transpedicular spinal biopsy (PTSB), along with advanced diagnostic methods in pathology, enables accurate diagnosis of pathological spinal lesions. Our goal was to determine the accuracy and clinical usefulness of this procedure in patients with suspected pathology of spine. Method: C-Arm guided PTSB was performed in 50 patients with osseous spinal lesions as a day care procedure. Basic blood investigations were obtained prior to procedure. Biopsy was performed using 13-gauge Jamshidi needle under local anesthesia. Haemorrhagic fluid obtained along with the specimens was sent for microbiological studies when clinically indicated. Results: The level of biopsy was thoracic in 22, lumbar in 27 and sacral in 1. In 46 patients, bone tissue was obtained while in 4 patients, soft tissue was obtained. Haemorrhagic fluid was also aspirated along with biopsy specimens. In 38 patients, a clinico-radiological diagnosis of infective pathology was made. Overall, the biopsy was positive in 44 (88%) cases, out of which diagnosis was confirmed in 27 cases (61.4%). Conclusion: C-Arm guided PTSB is an important tool in the evaluation of spinal lesions. It is technically easy, quick, reliable, safe, cost-effective procedure and can eliminate need for open biopsy of the spine. It should be done in all patients with suspected osseous spinal pathology to avoid mismanagement as in many cases the clinico-radiological diagnosis may differ from histological diagnosis.