Published: 2017-10-25

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

Puneet Chamakeri, Anil Bulagond, Srikant Kulkarni, Sharad Shirol, Vijay Patil


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.



Fluoroscopic, Percutaneous transpedicular, Vertebral body lesions

Full Text:



Cuénod CA, Laredo JD, Chevret S, Hamze B, Naouri JF, Chapaux X, et al. Acute vertebral collapse due to osteoporosis or malignancy:Appearance on unenhanced and gadolinium‑enhanced MR images. Radiology. 1996;199(2):541‑9.

Jung HS, Jee WH, McCauley TR, Ha KY, Choi KH. Discrimination of metastatic from acute osteoporotic compression spinal fractures with MR imaging. Radiographics. 2003;23(1):179‑87.

Dupuy DE, Rosenberg AE, Punyaratabandhu T, Tan MH, Mankin HJ. Accuracy of CT-guided needle biopsy of musculoskeletal neoplasms. American J Roentgenol. 1998;171(3):759–62.

Mankin HJ, Lange TA, Spanier SS. The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors. J Bone Joint Surg Am. 1982;64:1121–7.

Murphy WA, Destouet JM, Gilula LA. Percutaneous skeletal biopsy 1981: a procedure for radiologists – results, review, and recommendations. Radiology. 1981;139:545–9.

DeSantos LA, Lukeman JM, Wallace S, Murray JA, Ayala AG. Percutaneous needle biopsy of bone in the cancer patient. American Journal of Roentgenology 1978;130:641–9.

Robertson RC, Ball RP. Destructive spine lesions: diagnosis by needle biopsy. J Bone Joint Surg. 1935;57:749–58.

Stringham DR, Hadjipavlou A, Dzioba RB, Lander P. Percutaneous transpedicular biopsy of the spine. Spine (Phila Pa 1976). 1994;19:1985–91.

An HS, Andreshak TG, Nguyen C, Williams A, Daniels D. Can we distinguish between benign versus malignant compression fractures of the spine by magnetic resonance imaging? Spine (Phila Pa 1976). 1995;20:1776‑82.

Shindle MK, Tyler W, Edobor‑Osula F, Gardner MJ, Shindle L, Toro J, et al. Unsuspected lymphoma diagnosed with use of biopsy during kyphoplasty. J Bone Joint Surg Am. 2006;88:2721‑4.

Schoenfeld AJ, Dinicola NJ, Ehrler DM, Koerber A, Paxos M, Shorten SD, et al. Retrospective review of biopsy results following percutaneous fixation of vertebral compression fractures. Injury. 2008;39:32-3.

Muijs SP, Akkermans PA, Van Erkel AR, Dijkstra SD. The value of routinely performing a bone biopsy during percutaneous vertebroplasty in treatment of osteoporotic vertebral compression fractures. Spine (Phila Pa 1976). 2009;34:2395‑9.

Fyfe I, Henry APJ, Mulholland RC. Closed vertebral biopsy. J Bone Joint Surg. 1983;65:140-3.

Laredo JD, Bard M. Thoracic spine: percutaneous trephine biopsy. Radiology 1986;160:485-9.

Stoker DJ, Kissin CM. Percutaneous vertebral biopsy: a review of 135 cases. Clin Radiol. 1985;36:569-77.

Victor Babu N, Titus VTK, Chittaranjan S, Abraham G, Prem H, Korula RJ. Computed tomographically guided biopsy of the spine. Spine. 1994;19:2436-42.

Pierot L, Boulin A. Percutaneous biopsy of the thoracic and lumbar spine: transpedicular approach under fluoroscopic guidance. AJNR Am J Neuroradiol. 1999;20:23–5.

Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumours of the spine: A 42‑year survey from the Leeds Regional Bone Tumour Registry. Eur Spine J. 2007;16:405‑9.

Latif T, Hussein MA. Advances in multiple myeloma and spine disease. Clin Lymphoma Myeloma. 2005;6:228‑33.