The clinical utility of fluoroscopic versus CT guided percutaneous transpedicular core needle biopsy for spinal infections and tumours: a randomized trial

Lee, She Ann; Chiu, Chee Kidd; Chan, Chris Yin Wei; Yaakup, Nur Adura; Wong, Jeannie Hsiu Ding; Kadir, Khairul Azmi Abd; Kwan, Mun Keong

doi:10.1016/j.spinee.2020.03.015

Cited by 17 publications

(19 citation statements)

References 34 publications

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“…Percutaneous CT-guided vertebral biopsy is a relatively safe and accurate diagnostic tool with complication rates ranging from 0 to 10% in recent studies. 4,[19][20][21] Overall, our complication rate was only marginally higher than that reported elsewhere; complications were seen in 8 out of 67 patients (11.94%). This could be attributable to a higher proportion of thoracic vertebral lesions in our study for which the more challenging costotransverse approach had to be employed.…”

Section: Discussioncontrasting

confidence: 65%

Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Singh

Sharma

Boruah

et al. 2020

Journal of Clinical Interventional Radiology ISVIR

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Introduction Computed tomography (CT)-guided vertebral biopsy is always recommended for histopathological and microbiological confirmation in cases of tuberculous spondylodiscitis and for antimycobacterial drug sensitivity testing. Aim To compare the conventional technique and a novel axis-defined tram-track technique of CT-guided vertebral biopsy in suspected tuberculous spondylodiscitis. Materials and Methods Sixty-seven patients of clinico-radiologically suspected tuberculous spondylodiscitis referred for CT-guided vertebral biopsy were categorized into two groups: “Group A” patients (n = 32) underwent biopsy by conventional technique, and “Group B” patients (n = 35) by axis-defined tram-track technique. The time taken for procedure, radiation exposure, and any procedural complications were recorded for both the groups. Results A statistically significant difference in procedure time and mean radiation dose was observed between the two groups: a longer procedural time was required in “Group A” (52.5 ± 3.5 minutes) as compared to “Group B” (37.3 ± 3.6 minutes) (p < 0.0001); and mean radiation dose (CTDIvol) in “Group A” and “Group B” was 8.64 ± 1.06 mGy and 5.73 ± 0.71 mGy, respectively (p < 0.0001). However, the difference in complication rate and tissue yield for successful diagnosis of the biopsies in the two groups was found to be statistically insignificant. Conclusion Axis-defined tram-track technique was found to have a significantly shorter procedural time as well as lower radiation exposure compared to the conventional technique of vertebral biopsy in our study.

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Section: Discussioncontrasting

confidence: 65%

Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Singh

Sharma

Boruah

et al. 2020

Journal of Clinical Interventional Radiology ISVIR

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“…Traditionally, an open biopsy was performed to obtain tissue samples from a spinal lesion [1]. Since the inception of percutaneous biopsy of the spinal lesion, it has become the procedure of choice owing to the less invasive nature of the procedure, thus allowing faster recovery of the patients [3][4][5]. A percutaneous spinal biopsy can be performed in two ways: either with computed tomography (CT)-guided or fluoroscopyguided [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

“…CT-guided biopsy offers exceptional visualisation of spinal tumours at a cost of increased radiation exposure to the operating personnel [3]. The radiation exposure to the operating personnel is 26 times higher in the CT-guided group compared to the fluoroscopy-guided group [3]. Despite the poorer spatial resolution, fluoroscopy-guided biopsy of spinal lesions has been proven to be a feasible alternative to CT-guided biopsy [3,[11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Accuracy and Adequacy of Computed Tomography Versus Fluoroscopy-Guided Percutaneous Transpedicular Biopsy of Spinal Lesions

Zakaria@Mohamad¹,

Rahim²,

Kow³

et al. 2022

Cureus

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BackgroundTranspedicular biopsy of spinal lesions is imperative for the generation of a definite diagnosis. Thus far, literature comparing the accuracy and adequacy between fluoroscopy-guided and computed tomography (CT)-guided transpedicular biopsy of spinal lesions is scarce. We aim to compare the accuracy and adequacy of samples collected with the two techniques at the largest tertiary hospital in Malaysia. Materials and methodsA total of 60 patients (37 patients with spinal infection and 23 patients with spinal tumour) underwent percutaneous transpedicular biopsy of spinal lesions from January 2013 to December 2017 at a tertiary centre. Demographic data, biopsy method (fluoroscopy-guided and CT-guided), diagnosis, adequacy, and accuracy of samples obtained were assessed. ResultsAmong the 60 samples obtained, only two samples (3.3%) were deemed inadequate. There were 10 biopsy samples (16.7%) that were inaccurate. There was no statistical difference between fluoroscopy-guided and CT-guided transpedicular biopsy in terms of accuracy (p = 0.731) and adequacy (p = 0.492). ConclusionsFluoroscopy-guided and CT-guided transpedicular biopsy of spinal lesions offer similar accuracy and adequacy. Fluoroscopy-guided biopsy of the spinal lesion will be an option for spine surgeons when CTguided biopsy is not available.

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“…1,4,5,8,10,11 To date, spine biopsy has been traditionally performed under CT or fluoroscopy alone, this however has logistic and technical limitations, such as the high radiation dose and lack of visualization of the nearby structures, respectively. 16,17 CBCT has been increasingly used for percutaneous spine procedures and has been demonstrated to be reliable and accurate as a guiding imaging technique. 18 In our study we found that CBCT guided spine biopsy for spondylodiscitis showed an overall microbiologic yield comparable to fluoroscopy or CT guided biopsy (yield ranging from 30-40%), in patients with prior antibiotic exposure.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous spine biopsy under cone beam computed tomography guidance for spondylodiscitis: Time is diagnosis

et al. 2021

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Background and purpose Percutaneous spine biopsies for spondylodiscitis have been long discussed due to the low microbiologic yield. This retrospective study evaluated factors of cone beam computed tomography-guided spine biopsies that may affect microbiologic yield. Methods We retrospectively reviewed percutaneous spine biopsies under cone beam computed tomography for spondylodiscitis performed from January 2015–December 2020. Clinical and technical features such as the time from initial symptoms to biopsy, level biopsied, biopsy needle type/gauge, technical approach, radiation dose, technical success and microbiologic yield were recorded. Pre-procedure magnetic resonance imaging findings were also recorded such as the number of vertebral bodies involved, and disc morphology. Univariate logistic regression analysis and Receiver operating characteristic analysis were performed to assess any relationship between relevant factors and positive cultures. Results A total of 50 patients underwent cone beam computed tomography-guided biopsies for spondylodiscitis, with resulted positive cultures in 18 patients (36%). The mean time from the initial referral of spinal symptoms to procedure in the positive culture group was the most influential finding for positive cultures (odds ratio 56.3, p < 0.001). Among magnetic resonance imaging findings, thin or degenerated intervertebral disc was a negative factor for positive cultures (odds ratio 0.09, p = 0.006). Univariate analysis showed that percutaneous approach (transpedicular vs posterolateral/interlaminar) needle size (11–13 g vs 16–18G, odds ratio 1.2, p = 0.7) and site of biopsy (disc vs bone vs disc plus endplate) did not significantly affect the microbiologic yield of spine biopsy. Conclusion Percutaneous cone beam computed tomography-guided biopsy for spondylodiscitis is a reliable and safe technique and its microbiologic yield may increase if biopsy is performed within the acute phase of infection.

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The clinical utility of fluoroscopic versus CT guided percutaneous transpedicular core needle biopsy for spinal infections and tumours: a randomized trial

Cited by 17 publications

References 34 publications

Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Computed Tomography-Guided Vertebral Biopsy in Suspected Tuberculous Spondylodiscitis: Comparing a New Navigational Tram-Track Technique versus Conventional Method

Diagnostic Accuracy and Adequacy of Computed Tomography Versus Fluoroscopy-Guided Percutaneous Transpedicular Biopsy of Spinal Lesions

Percutaneous spine biopsy under cone beam computed tomography guidance for spondylodiscitis: Time is diagnosis

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