Evaluation of percutaneous spinal biopsy in dorsolumbar spinal lesions under image guidance

Background and purpose: The presence of a spinal lesion, whether symptomatic or not, presents a diagnostic challenge as many a times clinicoradiological diagnosis differs from tissue diagnosis. Percutaneous transpedicular spinal biopsy (PTSB), along with advanced diagnostic methods in pathology, enable accurate diagnosis of pathological spinal lesions. Our goal was to determine the accuracy and clinical usefulness of this procedure in patients with suspected pathology of spine. Method: Image-guided PTSB was performed in 50 patients with osseous spinal lesions as a day care procedure. Basic blood investigations of all patients were obtained prior to procedure. All the biopsies were done in operating room under sterile conditions, under local anesthesia. In all patients biopsy was performed using 13-gauge Jamshidi needle. Biopsy specimens were sent for histolopathological/cytopathological analysis depending upon the nature of tissue retrieved. Haemorrhagic fluid obtained along with the specimens was sent for microbiological studies when clinically indicated. Results: The patients were between 10 years to 78 years, with a mean age of 49 years. 27 patients were male and 23 were female. The level of biopsy was thoracic in 22, lumbar in 27 and sacral in 1. In 46 patients, bone tissue was obtained and in the remaining 4, soft tissue was obtained. Haemorrhagic fluid was also aspirated along with biopsy specimens. In 38 patients, a clinicoradiological diagnosis of infective pathology was made. The biopsy report confirmed infective pathology in 16 patients, while in 2 patients the report suggested of neoplastic pathology. In the remaining 12 cases, clinicoradiological diagnosis was neoplastic pathology. The biopsy report confirmed neoplastic pathology in 8 patients, while in 1 patient report suggested of infective pathology. The remaining 17 reports suggested inflammatory pathology. Overall, the biopsy was positive in 44 (88%) cases, out of which diagnosis was confirmed in 27 cases (61.4%). In the remaining patients, 4 samples were suggestive of necrosis and 2 were inadequate to provide a diagnosis. Conclusion: Image-guided PTSB is an important tool in the evaluation of spinal lesions. It is technically easy, quick, reliable, safe, cost-effective, can be done as an outdoor procedure by any orthopaedic surgeon and can eliminate need for open biopsy of the spine. It should be done in all patients with suspected osseous spinal pathology to avoid mismanagement as in many cases the clinicoradiological diagnosis may differ from histological diagnosis.