Image-Guided Percutaneous Spine Biopsy by A. Orlando Ortiz

Author:A. Orlando Ortiz
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

 Limited or no specimen yield may result in false negative biopsy

Lesion location

 Defer biopsy for lesions located adjacent to critical structures or inaccessible locations

Preexisting infection at the skin site, such as a cellulitis or a decubitus ulcer, can sometimes occur near the intended area for possible percutaneous biopsy. Infection at the skin site or within the soft tissues surrounding a tumor can be considered a contraindication to percutaneous biopsy (Peh 2003; Hodge 1997; Ghelman 1998). Although unlikely, the spread of the infection into deep soft tissues, tumor, or within the vertebral body can occur if a soft tissue infection, such as a cellulitis, is not treated prior to biopsy. Consultation with an infectious disease specialist may be necessary to optimize antibiotic therapy and provide medical clearance prior to biopsy. Patients who are uncooperative or unstable are not candidates for image-guided lumbar spine biopsy (Peh 2006). If a patient is clinically unstable, it is prudent to wait until the patient is medically stabilized as well as to consult with the patient’s clinical providers in order to assess for the urgency and clinical need for a biopsy. With respect to uncooperative patients, after discussion with the appropriate patient representative and requesting provider, a clinically necessary lumbar spine biopsy can be performed under general anesthesia or monitored anesthesia care. The risk and benefits of the anesthesia and the need for tissue diagnosis must be carefully assessed in order to appropriately triage candidates for the procedure. The type of lesion may also influence whether or not a biopsy gets performed. Hypervascular lesions may dissuade an operator for fear of a hemorrhagic event. The operator should try to avoid performing biopsy procedures in cases where the radiographic features are highly suggestive or pathognomonic of a benign lesion (Figs. 6.2 and 6.3). Very small (less than 5 mm diameter) lesions may not be amenable to biopsy; it just may not be possible to obtain tissue. Lesions, especially small lesions, that are located near critical structures such as the spinal cord, lung, or aorta may also not be amenable to percutaneous biopsy.

Fig. 6.2Axial CT image shows posterolateral approach with bone biopsy needle (arrow) for biopsy of a round sclerotic lesion with a lucent center at the vertebral endplate. This is a Schmorl’s node and a biopsy was not necessary

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