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

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'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'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. Spinal Cord (2009) 47, 384-389; doi:10.1038/sc.2008.108; published online 23 September 2008