1. Active hemorrhage
3. Vascular injury
4. Neural injury (spinal cord or nerve) resulting in transient or permanent paralysis
6. Infection, including meningitis biopsy procedure, the operator should carefully scrutinize all pertinent imaging studies. This will help identify the optimal lesion(s) for biopsy and the safest approach to access the lesion(s). Furthermore, this pre-procedure evaluation can assist in the selection of the appropriate needles and imaging modality.
Percutaneous spine biopsy can be performed with local anesthesia, with local anesthesia and conscious sedation, or under general anesthesia. The procedure is often performed with a combination of local anesthesia and intravenous conscious sedation using a short-acting benzodiazepine (Versed) and an analgesic such as fentanyl or morphine. While general endotracheal anesthesia is often not utilized owing to the requirement for prone positioning of the patient, general intravenous anesthesia can be performed with propofol. To minimize the possibility of infection, the study should be performed with strict aseptic technique.
Patient positioning depends upon the spine level (cervical, thoracic, or lumbosacral) of the lesion and its location (vertebral body vs posterior elements). The prone position is optimal for accessing lesions in the thoracic or lumbosacral spine or, rarely, within the posterior aspect of the cervical spine. The supine position is usually required to access the cervical spine. In certain instances—for example, when a patient cannot lie completely prone—the lateral decubitus or prone oblique position can be helpful (Figure 5.2). Patient monitoring is performed with the help of a pulse oximeter, continuous electrocardiography, and
an automated blood pressure cuff. Appropriate placement of the monitoring equipment is required so that it does not obscure the field of view during the procedure and does not contaminate the sterile field. An intravenous catheter should also be in place prior to the procedure to facilitate the intravenous administration of medications, contrast agents, or hydration. The antecubital fossa should be avoided in situations that require prone positioning of the patient: the patient's elbows are often flexed in this position, and the intravenous catheter function can be compromised.
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