Percutaneous transpedicular biopsy of the spine

Abstract

Study design: Despite increasing information regarding pedicular instrumentation, the transpedicular biopsy of the vertebral body has not been popularized. The precise technique for percutaneous transpedicular biopsy and the volume of the vertebral body accessible through the pedicle has not been reported.

Objective: To describe the percutaneous transpedicular biopsy, its diagnostic yield, to determine the amount of bone retrievable through the pedicle.

Summary of background data: Experience gained from open biopsy facilitates the development of the percutaneous technique. There were no complications with the open or closed procedures.

Methods: Transpedicular biopsy was performed on 18 patients (nine open and nine percutaneous). Unilateral transpedicular curetments were performed on the cadaveric lumbar spines. The volume of the vertebral body accessible through the pedicle was determined using roentgenograms, computed tomography, and image analysis.

Results: Adequate specimens for a correct diagnosis were obtained in all biopsies. Laboratory volumetric analysis demonstrated that more than 50% of the volume of a lumbar vertebral body is accessible through a unilateral transpedicular approach, without compromising the anatomic structure of the pedicle.

Conclusions: The vertebral pedicle provides a safe conduit for biopsy of most vertebral body lesions. Percutaneous transpedicular biopsy can be performed with minimal morbidity and high diagnostic yield.