Publication:

Fluroscopic guided percutaneous transpedicular biopsy of vertebral body lesion: a safe and effective procedure

Background Vertebral biopsy is suitable for patients with intractable back pain and vertebral body lesions that are detected with noninvasive imaging modalities. Histologic confirmation is necessary for correct diagnosis and subsequent clinical management. Percutaneous biopsy is less invasive and cost-effective.

Methods Twenty three patients with history of severe back pain with vertebral body lesion identified by any of computed tomography (CT) or magnetic resonance imaging (MRI) were taken up for percutaneous biopsy. Lesion level was determined under fluoroscopy. Biopsy was taken with trephine needle under local anesthesia. Accuracy and effectiveness analyzed after histologic reports.

Results Among 23 patients, 2 were having malignant primary lesions (8.6%), 8 were having vertebral metastasis (35%), 10 were having infectious etiology (43.4%) and 3 were osteoporotic fractures. There were no complications. One unsuspected secondary malignancy was detected. True positive cases were 19; true negative cases were 3 and one false negative case. Overall accuracy is 95%.

Conclusions This minimal invasive technique is simple, safe and effective in diagnosis of malignancy and infection aiding the treating surgeon in their further management. It is also useful in detecting unsuspected malignancy.