Spine Biopsy

A. Orlando Ortiz and Gregg H. Zoarski

Prior to the development of imaged-guided percutaneous spine biopsy techniques, an open biopsy procedure was required for definitive diagnosis. The advantage of the open biopsy procedure is twofold. First, under direct visualization multiple, and larger, tissue samples can be obtained and made available for frozen histopathological analysis. Second, the open biopsy can be performed as part of a surgical decompression and/or stabilization procedure of the spine. The first report of percutaneous spine biopsy was in 1935 by Robertson and Ball.1 Their procedures, however, did not utilize imaging guidance. Siffert and Arkin utilized a posterolateral approach for spine biopsy using radiographic guidance.2 Fluoroscopy-guided spine biopsy was subsequently reported in 1969, and CT-guided spine biopsy was reported in 1981.3,4 Percutaneous spine biopsy has several advantages over an open biopsy procedure. The percutaneous image-guided procedure is faster and more cost-effective and has an overall lower risk of complications.5

Image-guided spine biopsy procedures are usually performed to diagnose suspected primary or secondary neoplastic processes or to evaluate for the presence of infectious spondylitis.6 These procedures are less frequently performed to assess for other noninfectious inflammatory conditions that can affect the spine. The decision to perform a spine biopsy procedure is made after close communication between the radiologist and the referring clinician. Both individuals must be convinced that the benefit to be gained from the biopsy results firmly outweighs the risks of the procedure. To this end, as a prerequisite, there must be a thorough medical history and physical examination combined with a complete review of all prior imaging and laboratory examinations. This consultation will avoid unnecessary spine biopsies (when they are not indicated or when a more accessible bone biopsy site, such as the iliac bone, is available), ensure patient safety, and identify the optimal location and level for performing the biopsy procedure.

Spine biopsy is often performed to evaluate destructive or space-occupying lesions within the spinal axis (Table 5.1). Abnormal foci of marrow replacement within the vertebral column that are detected

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