Biopsy Techniques

An important decision that is made before and during spine biopsy is the choice of approach. The determinants for the approach are lesion location and lesion size (Table 5.4).14 A posterior approach is used for thoracic, lumbosacral, and posterior cervical lesions. An anterior approach is used for most cervical spine biopsies. The location of "critical" normal anatomical structures will also modify the approach. Unless the lesion is clearly localized to the left side of the spine, for example, a right-sided approach is preferable to a left-sided approach for accessing thoracic spine tumors without damaging the aorta. In the cervical spine, the critical structures include the great vessels of the neck, the pharynx and hypopharynx, the trachea, the esophagus, the thyroid gland, the lung apices, and the spinal cord. In the thoracic spine, the critical structures are the lungs and the aorta. In the lumbar spine, the critical structures are the aorta, inferior vena cava, kidneys, large and small bowel, conus, and exiting spinal nerves. The objective is to choose a trajectory that enables access to the lesion without compromising normal, critical structures (Figure 5.4).

The specific location of the lesion within the spine will also influence the approach that is selected. A vertebral body lesion and a posterior element lesion (Figure 5.5) will be approached differently. The type of posterior approach (posterolateral, transpedicular, or transcostovertebral)

Table 5.4. Biopsy approaches

Location

Approach

Spine level

Bone

Paraspinal oblique

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