Vertebral Spine Biopsy

CT-guided percutaneous vertebral biopsy
A definitive tissue diagnosis of a vertebral lesion can be made with a minimally invasive, safe, and accurate method called CT-guided percutaneous vertebral biopsy. The most effective substitute for a surgical biopsy is frequently a CT-guided vertebral biopsy. The identification of spinal lesions is mostly dependent on magnetic resonance imaging (MRI). Even while recent advances in MRI now make it possible to recognize and suspect the nature of vertebral lesions and positron emission tomography-computed tomography (PET-CT) provides data on lesion metabolism, a biopsy is still required in the majority of instances. Both open surgery and a less invasive (percutaneous imaging-guided) procedure can be used to confirm the histopathology of a vertebral lesion. An open surgical biopsy of a vertebral lesion has a high risk of morbidity, the potential for contamination of nearby tissue planes, and potential postoperative problems. Under the direction of computed tomography, a percutaneous imaging-guided biopsy of a vertebral lesion can be carried out (CT). When possible, percutaneous CT-guided biopsy of the vertebral lesion is preferred over open procedures since it is a safe, reliable, and accurate diagnostic tool. The diagnosis of suspected spondylodiscitis, histopathology, and microbiological tests; diagnosis of atraumatic vertebral fractures of unknown origin with differentiation between osteoporotic, neoplastic, and inflammatory fractures; histological characterization of a focal vertebral lesion; characterization of suspected as well as known spinal metastasis, receptor/immunohistochemical analyses; The approach-based methodologies for CT-guided percutaneous vertebral biopsy will be highlighted in this technical note.

In comparison to standard blood tests, a slightly larger needle is utilized during the biopsy. The back of the hip's bone must be punctured with this larger needle. Following the biopsy, the bone hole will start to heal right away, and it is anticipated that full healing will have taken place in 1 to 2 weeks.  

Technique

The CT-guided biopsy of vertebral lesions can be performed using a variety of approach-based approaches. These methods rely on a variety of variables, including the following: Location within the vertebrae, localized or diffuse lesion, location within the spinal column, such as the cervical, thoracic, or lumbar spine, vertebral plana, and accompanying soft tissue mass. Conscious sedation or local anesthetic is typically used during CT-guided vertebral biopsy procedures. Patients with comorbidities, those unable to lie prone, and young patients all necessitate general anesthetic.

The three Ps—"planning" for a successful biopsy, "positioning" the patient to achieve the ideal biopsy plane, and "protection" of vital vascular and neural structures in the trajectory of a biopsy needle—are the best way to express the key principles for a successful and safe CT-guided vertebral biopsy. Most CT-guided percutaneous vertebral biopsy procedures for the thoracic and lumbar vertebrae are carried out with the patient on their back. Patient posture for cervical vertebrae is influenced by the spot where the lesion is, how the biopsy is done, and the operator's competence level. The patient is positioned prone on the table for direct posterior and posterolateral approaches. The patient is positioned in the decubitus posture with the side of the lesion facing upwards for the direct lateral approach. In order to do the anterolateral approach, the patient is lying face down.

The numerous vertebral biopsy techniques include:-

Ø Transpedicular technique

Ø Posterolateral extravehicular technique

Ø Superior costotransverse technique

Ø Inferior costotransverse technique

Ø Pedicular biopsy

Ø Anterolateral or lateral technique

Ø Dual biopsy

Conclusion

The most effective alternative to open surgical vertebral biopsy for the accurate and safe outpatient diagnosis of the vertebral lesion is a CT-guided percutaneous vertebral biopsy. The rule of the three Ps, rigorous step-by-step planning, and customization of the approach based on the vertebral level involved are crucial to the procedure's effectiveness with the highest level of safety. The requirement for open surgical biopsy can be avoided by utilizing the discussed least invasive approach-based procedures.

Location: India

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