Percutaneous Transpedicular Biopsy of Vertebral Body Lesions

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Abstract
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 outpatients, 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.