Transpedicular percutaneous biopsy of vertebral body lesions: a series of 71 cases

Abstract

Study design: This prospective study evaluates the effectiveness of transpedicular biopsy carried out under local anesthesia in obtaining diagnostic tissue from vertebral body lesions. Objective: To describe the technique of percutaneous transpedicular biopsy carried out under local anesthesia under C-arm fluoroscopy and to report the author 0 s experience. Setting: Spine hospital, Ahmedabad, Gujarat, India. Methods: Seventy-one patients who underwent transpedicular biopsy from T6 to S1 vertebral body lesions were evaluated. Biopsy specimens were obtained by passing a self-designed 5-mm diameter biopsy instrument through the pedicle into the site of the disease using C-arm fluoroscopy. Specimens were sent for histological and bacteriologic analyses. Results: Biopsy was carried out for vertebral lesions of 51 men and 20 women. Sixteen of these lesions were seen in thoracic spine, 53 in lumbar and two in sacrum. The pathologic examinations revealed infections in 25, osteoporotic wedging in 21, metastasis in eight, plasmacytoma in three, multiple myeloma in four, non-Hodgkin 0 s lymphoma in one and round cell tumor in one patient. Diagnosis was established in 63 of 71 patients (88.7%). Remaining eight patients were reported as chronic nonspecific inflammation, and were followed up for more than 6 months. Conclusion: Percutaneous transpedicular vertebral biopsy under local anesthesia is an important tool in the evaluation of vertebral body lesions, especially in older population and can be performed with minimal morbidity and high diagnostic yield as an outpatient procedure.

Diagnostic Yield of Fluoroscopy-Guided Biopsy for Infectious Spondylitis

“…Our results are comparable with those in other large studies of CT guidance. 3,7,9 Our results are also consistent with those of Nourbakhsh et al, 28 who…”

“…There have been few large studies of fluoroscopy-guided percutaneous biopsy for infectious spondylitis, and compared with a high accuracy rate for confirmation of neoplastic spinal lesions, 3,[7][8][9] percutaneous spinal biopsy for bacteriologic diagnosis has a variable rate of reported success in patients with spondylitis. 10,11 Even in more recent studies, 12,13 the identification of a causative organism proved impossible in a number of cases, and empiric antibiotic therapy had to be used.…”

Fluoroscopy Guided Percutaneous Transpedicular Biopsy for Thoracic and Lumbar Vertebral Body Lesion: Technique and Safety in 23 Consecutive Cases

“…Certain area of vertebral body are considered inaccessible for trajectory of percutaneous transpedicular biopsy such as vertebral body just anterior to spinal canal and inferior and superior edge of posterior body. 5,12 Since the mouth of arthroscopic punch or grasper can be rotated in different direction, larger are of vertebral body could be assessed. But bones obtained with arthroscopic punch or grasper can give rise to crush artifacts in histological examination and should be discussed with pathologist before reporting.…”

Role of image intensified fluoroscopy guided closed vertebral biopsy in perplexed lesions of spine: A retrospective study

“…This is in congruence with the study findings conducted at different parts of the globe. ( [6,15,[18][19][20] . whereas a lower yield was observed in studies conducted by Tehranzadeh et al [21] .…”