PERCUTANEOUS TRANSPEDICULAR BIOPSY OF VERTEBRAL BODY LESIONS

Study Design. This prospective study evaluates the use of transpedicul ar biopsy in obtaining diagnostic tissue from vertebral body lesions. Objective. To report the authors' experience of all (N = 32) percutane ous transpedicular biopsies performed between 1990-1994. Summary of Ba ckground Data. Previous articles have discussed the value of open biop sy of the vertebral body using a Craig needle. A large series of close d percutaneous transpedicular biopsies have not been reported. Methods . The authors evaluated 32 patients (26 outpatients, six inpatients) w ho underwent transpedicular biopsy for T1-L4 lesions of the vertebral bodies. None of the tumors had an extraosseous component. Biopsy speci mens 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 th e pedicle into the site of disease in all patients, as confirmed by C- arm fluoroscopy or computed tomography. There were 22 malignancies; fo ur isolated compression fractures, two at T6, one at T7, one at T8; fo ur cases of infection or inflammation; and one case each of Paget's di sease 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. The re were no complications. Conclusions. Transpedicular biopsy of deep v ertebral body lesions using a bone biopsy needle under computed tomogr aphy or fluoroscopy guidance can be performed safely and efficaciously as an outpatient procedure.