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Anterolateral

Cervical

Sclerotic Lesion Vertebral Body
Figure 5.4. Axial CT image shows a localizing needle adjacent to the right pedicle (long arrow) of a lumbar vertebra. A transpedicular approach was chosen to access the most proximal (small arrow) of three sclerotic lesions in a patient with a history of breast cancer.
Lumbar Pedicle Image
Figure 5.5. Axial CT image shows an expansile lytic lesion within the right transverse process and posterior vertebral body of this thoracic vertebra. Fine-needle aspiration of the right transverse process (arrow) was therefore performed with a 22-gauge Chiba needle.
Chiba Needle
Figure 5.6. Diagram of vertebra indicating the biopsy routes for the postero-lateral transpedicular, and transcostovertebral approaches. (Drawing modified with permission from Dr. Bernadette Stallmeyer.)

can be tailored to the specific location of the lesion (Figure 5.6). The posterolateral approach can be used to access lesions located within the vertebral body, disc, or paraspinal soft tissues of the lumbar spine (Figures 5.7 and 5.8). The transpedicular approach can be used to safely access lesions within the thoracic or lumbar vertebrae. A transcostovertebral approach can be used for thoracic disc space lesions, thoracic paraspinal soft tissue masses, or vertebral body lesions (Figure 5.9).

The selected imaging modality is used to identify the lesion level (Figure 5.10). Once a safe path to the target lesion has been chosen, sv

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