Percutaneous transpedicular biopsy of vertebral body lesions

Study Design. This prospective study evaluates the use of transpedicular biopsy in obtaining diagnostic tissue from vertebral body lesions. Objective. To report the authors' experience of all (N = 32) percutaneous transpedicular biopsies performed between 1990-1994. Summary of Background Data. Previous articles have discussed the value of open biopsy of the vertebral body using a Craig needle. A large series of closed percutaneous transpedicular biopsies have not been reported. Methods. The authors evaluated 32 patients (26 out-patients, six inpatients) who underwent transpedicular biopsy for T1-L4 lesions of the vertebral bodies. None of the tumors had an extraosseous component. Biopsy specimens were obtained from 25 lesions using C-arm fluoroscopy; seven were guided by computed tomography. All biopsies were performed with a 14- to 17-gauge bone biopsy needle. Results. The needle passed through the pedicle into the site of disease in all patients, as confirmed by C-arm fluoroscopy or computed tomography. There were 22 malignancies; four isolated compression fractures, two at T6, one at T7, one at T8; four cases of infection or inflammation; and one case each of Paget's disease and myelofibrosis. Two patients required a second biopsy because the tissue sample was suspicious for lymphoma but not diagnostic. All 26 outpatients were discharged after a 2- hour observation period. There were no complications. Conclusion. Transpedicular biopsy of deep vertebral body lesions using a bone biopsy needle under computed tomography or fluoroscopy guidance can be performed safely and efficaciously as an outpatient procedure.