Percutaneous Vertebral Biopsy Research Articles

Outcomes of Fluoroscopic Guided Percutaneous Transpedicular Vertebral Biopsy

Outcomes of Fluoroscopic Guided Percutaneous Transpedicular Vertebral Biopsy

Generalized lymphatic anomaly in adult patients: An eminently radiological diagnosis

Generalized lymphatic anomaly (GLA) is an uncommon congenital disease secondary to the proliferation of lymphatic vessels in any organ except the central nervous system. GLA has a wide spectrum of clinical and radiological presentations, among which osteolytic lesions are the most widespread, being the ribs the most commonly affected bone. GLA is diagnosed mainly in children and young adults; nevertheless, on rare occasions it can remain asymptomatic and be detected incidentally in older patients. We present an unusual case of GLA in an asymptomatic 54-year-old man who had atypically distributed, purely cystic bone lesions on CT; measuring the Hounsfield (HU) of these lesions enabled us to suspect GLA. This suspicion was confirmed with MRI, PET/CT, CT-guided fine-needle aspiration biopsy, and fluoroscopy-guided percutaneous vertebral biopsy. After surgical resection of one of the lesions, histologic study provided the definitive diagnosis.

Anomalía linfática generalizada en un paciente adulto, un diagnóstico eminentemente radiológico

Generalized lymphatic anomaly (GLA) is an uncommon congenital disease secondary to the proliferation of lymphatic vessels in any organ except the central nervous system. GLA has a wide spectrum of clinical and radiological presentations, among which osteolytic lesions are the most widespread, being the ribs the most commonly affected bone. GLA is diagnosed mainly in children and young adults; nevertheless, on rare occasions it can remain asymptomatic and be detected incidentally in older patients. We present an unusual case of GLA in an asymptomatic 54-year-old man who had atypically distributed, purely cystic bone lesions on CT; measuring the Hounsfield (HU) of these lesions enabled us to suspect GLA. This suspicion was confirmed with MRI, PET/CT, CT-guided fine-needle aspiration biopsy, and fluoroscopy-guided percutaneous vertebral biopsy. After surgical resection of one of the lesions, histologic study provided the definitive diagnosis.

Clinical Study of a New Design Percutaneous Transpedicular Biopsy System for Spinal Tuberculosis

Purpose: Despite some spinal tuberculosis cases having typical imaging findings, histological/ microbiological evidence is required for definitive diagnosis and management. Percutaneous biopsy is suitable for histopathologic and bacteriologic evaluation of vertebral lesions, as it is a quick and minimally invasive technique to obtain specimens from deep structures and is advantageous for open surgical biopsy. Based on a minimally invasive technique, herein, we describe a newly designed percutaneous transpedicular biopsy system for lumbar vertebral lesion biopsy. Methods: Fifty-six patients who underwent percutaneous transpedicular vertebral biopsy under fluoroscopic guidance were evaluated. Biopsy specimens were obtained by passing a proprietary 6-mm diameter biopsy instrument through the pedicle and into the disease site under C-arm fluoroscopy. Specimens were sent for histological and bacteriologic analyses. Results: There were 36 males and 20 female patients of mean age 47.64 years (range 22-80 years). Biopsies were performed on 56 lumbar vertebral bodies. The average operative time were 15.6 minutes (range 13-18 minutes). All 56 patients (54 tubercular pathology, one metastasis, and one osteoporotic fracture with chronic nonspecific inflammation) had definitive histological/ microbiological diagnosis. Two patients (3.57% of 56 patients) developed a biopsy site small hematoma. Conclusions: A newly designed percutaneous transpedicular biopsy system was successfully used for lumbar vertebral biopsy under local anesthesia. It was easy to use and was safe with a low complication rate for definitive diagnosis of lumbar spinal tuberculosis and could be performed with minimal morbidity and high diagnostic yield as an outpatient procedure.

Approach-based techniques of CT-guided percutaneous vertebral biopsy.

Magnetic resonance imaging (MRI) plays an important role in the characterization of vertebral lesions. Even if latest improvements in MRI permit to understand and suspect the nature of vertebral lesions and positron emission tomography computed tomography (PET-CT) gives information about lesion metabolism, biopsy is still needed in most cases. CT-guided percutaneous vertebral biopsy is a minimally invasive, safe and accurate procedure for definitive tissue diagnosis of a vertebral lesion. CT-guided vertebral biopsy is often the best alternative to a surgical biopsy. The purpose of this technical note is to discuss the approach-based techniques for CT-guided percutaneous vertebral biopsy.

Imaging-guided percutaneous vertebral and paravertebral lesion biopsy: A single center experience

Aim: Percutaneous needle biopsy has been used successfully in the diagnosis of vertebral, paravertebral and disc diseases in recent years as it is a minimally invasive, safe, and effective method. The aim of this study was to share our experience with imaging-guided percutaneous vertebral and paravertebral biopsies.Methods: Images and data of 10 patients who underwent percutaneous vertebral and paravertebral biopsies between January 2018 and December 2019 were screened retrospectively through the hospital registry. The anatomical location of the lesion, guideline imaging method, number of samples taken, whether there were any complications after the procedure, needle diameter used, hemoglobin (Hb) values before and after the procedure were recorded.Results: Among 10 patients included in the study, 3 (30%) were male and 7 (70%) were female. The mean age of the patients was 63.5 (8.6) years. Biopsies were performed under computerized tomography and ultrasound guidance in nine patients and one patient, respectively. The lesion was located at the thoracic level in 4 patients (40%) and at the lumbar level in 6 patients (60%). Two samples were obtained from all patients. There were no complications. The mean Hemoglobin (Hb) values before and after the procedure were 10 (1.1) mg/dL and 10.2 (1.4) mg/dL, respectively, which were similar (P=0.91). 18G needle was used in all patients.Conclusion: Imaging-guided percutaneous vertebral and paravertebral biopsy is a safe and effective method which allows sampling for cytological, histological, and microbiological analysis. In the future, imaging techniques and biopsies will be increasingly used in the diagnosis of vertebral and paravertebral lesions.

Diagnostic yield and technical aspects of fluoroscopy-guided percutaneous transpedicular biopsy of the spine: A single-center retrospective analysis of outcomes and review of the literature.

Background:The technique of a percutaneous transpedicular biopsy of spinal lesions has been shown to be a useful alternative to paraspinal biopsy for vertebral body lesions in the thoracic and lumbosacral spine. Percutaneous vertebral biopsy is less invasive, cost-effective, and is suitable for patients with intractable back pain and vertebral body lesions that are detected with noninvasive imaging modalities.Objective:The purpose of this study was to establish the diagnostic utility and spectrum of fluoroscopy-guided percutaneous transpedicular biopsies of the thoracolumbar spine performed at our institution.Materials and Methods:This retrospective descriptive study to establish the diagnostic utility and spectrum of percutaneous fluroscopic guided transpedicular biopsy of lower thoracic and lumbar vertebral lesions has been performed on 42 patients in a tertiary care hospital between April 2017 and December 2019. There were 28 male patients and 14 female patients. The mean age was 48 years (range: 12–66 years). There were one 14 thoracic, 26 lumbar, and 2 sacral biopsy specimens. The lesion level was determined under fluoroscopy. Biopsy was taken with a trephine needle under local anesthesia. Accuracy and effectiveness of the technique were analyzed on histopathologic confirmation.Results:The fluoroscopic guided percutaneous transpedicular spine biopsies of 42 patients with spinal pathology were performed through the posterior transpedicular approach percutaneously. Of the 42 patients, 28 were male (66.7%) and 14 were female (33.3%). Vertebral involvement was observed to be more in the lower thoracic region (26.2%), followed by the upper dorsal region (7.1%), L1 (23.6%), L2 (6.4%), L3 (14.6%), L5 (17.3%), and sacrum (4.8%). There were 21 cases with tumor etiology (14 metastasis, 2 malignant round cell tumor, 2 multiple myeloma, and 3 lymphomas), 14 tuberculosis (TB), 4 osteomyelitis, 2 inflammatory, and 1 isolated compression fractures. Twelve patients of the 14 diagnosed cases who were diagnosed with TB on histopathology had positive TB culture and sensitivity pattern.Conclusion:Percutaneous transpedicular fluoroscopy-guided biopsy with a Jamshidi trocar with an internal diameter of 3.1 mm is a simple, safe, and reliable method for the etiological diagnosis of vertebral lesions. The use of this technique, however, is dependent on the accurate placement of the trocar and on close qualified interdisciplinary clinical cooperation. This minimally invasive technique is simple, safe, and effective in the diagnosis of malignant and infective lesions.

Fluoroscopy Guided Percutaneous Transpedicular Biopsy for Thoracic and Lumbar Vertebral Body Lesion: Technique and Safety in 23 Consecutive Cases.

Background Though some vertebral lesions have typical imaging findings, histological/ microbiological evidence are required for definitive diagnosis and management, specially for tumor and infective lesions so that wrong diagnosis and wrong treatment can be avoided. Conventionally, open biopsy methods are used. With availability of CT scan, MRI, percutaneous transpedicular vertebral biopsy has now become popular as a minimally invasive technique for biopsy of vertebral lesion. Objective To describes technique and to analyzes safety and feasibility of percutaneous transpedicular vertebral biopsy with fluoroscopy guidance for thoracic and lumbar vertebral body lesions. Method Twenty three patients who underwent percutaneous transpedicular vertebral biopsy under fluoroscopy guidance were retrospectively evaluated for demographic data, indication for biopsy, anatomical locations, histological/microbiological diagnosis, complications and final outcome of treatment. True positive, true negative, false positive and false negative cases were defined. Result There were 17 males and 6 female patients of mean age 47 (range 22-73 years). Biopsies were performed in 17 dorsal and six lumbar vertebral bodies. Adequate sample were obtained in all cases. Seventeen patients (12: tubercular pathology, 1: primary tumor, 3: metastasis, 1: osteoporotic fracture) had definitive histological/ microbiological diagnosis. Four patients had no granuloma and tumor. Two had histological features of chronic non specific inflammation. True positive cases were 17, true negative were four and false negative case were two. Overall accuracy was 92%. One patient developed small hematoma at biopsy site. Conclusion Fluoroscopy guided percutaneous transpedicular biopsy of is a safe procedure with high adequacy and accuracy and low complication rate for thoracic and lumbar vertebral body lesion.

Response to: Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures

Study design Retrospective observational study. Purpose To identify the role of percutaneous vertebral biopsy in histopathological diagnosis of vertebral compression fractures and to identify the frequency of unexpected malignancy in vertebral compression fractures. Overview of literature Vertebral compression fractures are common in the Indian population. Magnetic resonance imaging and nuclear imaging have some limitations in the diagnosis of definitive pathology of vertebral compression fractures. Therefore, histological confirmation is necessary for definitive diagnosis and to plan appropriate management for patient. Methods A retrospective observational study was conducted involving 84 patients who underwent percutaneous vertebral biopsy between 2010 and 2014. We performed C-arm guided percutaneous transpedicular core vertebral biopsy of vertebral compression fractures under combination of local anesthesia and intravenous conscious sedation. Results Sufficient biopsy material was obtained in 79 of the 84 cases. In the other five cases, biopsy material was not sufficient for reporting. Out of the 79 cases, osteoporotic pathology was detected in 69 patients, malignancy was detected in 8 patients and no pathology was found in 2 patients. Two patients with distant metastases to vertebra were identified. Primary spinal malignancy was detected in 6 patients (1 unsuspected plasmacytoma, 5 diagnosed malignancy preoperatively). So, the frequency of unsuspected malignancy of this study was 1.19% (1/84). None of the patients had any complications. Conclusions C-arm guided percutaneous transpedicular vertebral biopsy is useful in obtaining definitive histopathological diagnosis of vertebral compression fractures, especially in differentiating malignant and non-malignant vertebral compression fractures and helping plan appropriate management of patients. The rate of unexpected malignancy in vertebral compression fracture was 1.19%.

Letter to the Editor: Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures.

Letter to the Editor: Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures.

Accuracy of Percutaneous CT-Guided Spine Biopsy and Determinants of Biopsy Success.

Purpose: The purpose of this study was to investigate the accuracy of CT-guided spine biopsy as well as the factors that may influence its success.Methods and Materials: A total of 170 CT-guided biopsies performed on 156 patients with vertebral lesions were retrospectively analyzed. The accuracy of the biopsies was evaluated by comparing the final diagnosis with the biopsy results for patients who underwent surgery or with six-month clinical and radiological follow-up findings for patients who did not have surgery. The radiological features of each lesion, the features of the needles used, the needle approach, the pathology results, and the patient demographic data were statistically analyzed with Fisher exact test and ANOVA for their influence on the success of the biopsy.Results: The total success rate of percutaneous vertebral needle biopsies performed with CT guidance was 80 per cent (136/170). Age (p = 0.39), gender (p = 0.43), lesion location (p = 0.2), radiographic appearance (p = 0.8), needle type (p = 0.6), and approach (p = 0.1) had no effect on the adequacy of the obtained material or the success of the biopsy. There was a relationship between lesion histopathology and the rate of adequacy or success (p < 0.001). There was no relationship between the needle approach or the radiographic appearance of the lesion and the length of the specimen (p = 0.1). There were no major complications requiring treatment.Conclusion: The success rate of CT-guided percutaneous needle biopsy was close to that found in previous studies in the literature and independent of most patient parameters. Its complication rates are acceptable in experienced hands.

Role of Transpedicular Percutaneous Vertebral Biopsy for Diagnosis of Pathology in Vertebral Compression Fractures.

Study DesignRetrospective observational study.PurposeTo identify the role of percutaneous vertebral biopsy in histopathological diagnosis of vertebral compression fractures and to identify the frequency of unexpected malignancy in vertebral compression fractures.Overview of LiteratureVertebral compression fractures are common in the Indian population. Magnetic resonance imaging and nuclear imaging have some limitations in the diagnosis of definitive pathology of vertebral compression fractures. Therefore, histological confirmation is necessary for definitive diagnosis and to plan appropriate management for patient.MethodsA retrospective observational study was conducted involving 84 patients who underwent percutaneous vertebral biopsy between 2010 and 2014. We performed C-arm guided percutaneous transpedicular core vertebral biopsy of vertebral compression fractures under combination of local anesthesia and intravenous conscious sedation.ResultsSufficient biopsy material was obtained in 79 of the 84 cases. In the other five cases, biopsy material was not sufficient for reporting. Out of the 79 cases, osteoporotic pathology was detected in 69 patients, malignancy was detected in 8 patients and no pathology was found in 2 patients. Two patients with distant metastases to vertebra were identified. Primary spinal malignancy was detected in 6 patients (1 unsuspected plasmacytoma, 5 diagnosed malignancy preoperatively). So, the frequency of unsuspected malignancy of this study was 1.19% (1/84). None of the patients had any complications.ConclusionsC-arm guided percutaneous transpedicular vertebral biopsy is useful in obtaining definitive histopathological diagnosis of vertebral compression fractures, especially in differentiating malignant and non-malignant vertebral compression fractures and helping plan appropriate management of patients. The rate of unexpected malignancy in vertebral compression fracture was 1.19%.

Fluoroscopy-Guided Percutaneous Vertebral Body Biopsy Using a Novel Drill-Powered Device: Technical Case Series.

A novel coaxial biopsy system powered by a handheld drill has recently been introduced for percutaneous bone biopsy. This technical note describes our initial experience performing fluoroscopy-guided vertebral body biopsies with this system, compares the yield of drill-assisted biopsy specimens with those obtained using a manual technique, and assesses the histologic adequacy of specimens obtained with drill assistance. Medical records of all single-level, fluoroscopy-guided vertebral body biopsies were reviewed. Procedural complications were documented according to the Society of Interventional Radiology classification. The total length of bone core obtained from drill-assisted biopsies was compared with that of matched manual biopsies. Pathology reports were reviewed to determine the histologic adequacy of specimens obtained with drill assistance. Twenty eight drill-assisted percutaneous vertebral body biopsies met study inclusion criteria. No acute complications were reported. Of the 86% (24/28) of patients with clinical follow-up, no delayed complications were reported (median follow-up, 28weeks; range 5-115weeks). The median total length of bone core obtained from drill-assisted biopsies was 28mm (range 8-120mm). This was longer than that obtained from manual biopsies (median, 20mm; range 5-45mm; P=0.03). Crush artifact was present in 11% (3/28) of drill-assisted biopsy specimens, which in one case (3.6%; 1/28) precluded definitive diagnosis. A drill-assisted, coaxial biopsy system can be used to safely obtain vertebral body core specimens under fluoroscopic guidance. The higher bone core yield obtained with drill assistance may be offset by the presence of crush artifact.

Core Needle Percutaneous Transpedicular Vertebral Body Biopsy

We report an accurate technique for percutaneous transpedicular core needle biopsy of vertebral body lesions, and evaluate its effectiveness for histologic diagnosis retrospectively. The purpose of this study is to evaluate the effectiveness and accuracy of this method retrospectively. Better knowledge of vertebral pedicle morphometry has led to the development of transpedicular fixation techniques in spinal surgery. After experience with these techniques, we have been performing percutaneous transpedicular vertebral body core needle biopsies (transpedicular biopsy) for histologic diagnosis since 1993. A total of 128 patients who had undergone transpedicular biopsy for T1-L5 vertebral body lesions were evaluated. The biopsies were carried out under local anesthesia, except in children, for whom general anesthesia was used. Biopsy specimens were obtained by passing 8 or 11 G needle biopsy instruments percutaneously through the pedicle into the site of the lesion under C-arm fluoroscopy guidance. Histologic analyses were performed, and the accuracy and effectiveness of this technique were evaluated. The pathologic evaluations were definitive in 120 patients (93.8%) and not diagnostic in 8. The accuracy of the results differed among the diagnostic categories. Diagnostic accuracy was 78.6% for primary neoplasms and 97.0% for metastatic neoplasms. There was a significant difference in the diagnostic criteria and spinal segment. True positive rate was higher in the thoracic spine (92.2%) than that of lumbar spine (76.6%). Transpedicular biopsy is a useful procedure for evaluation of thoracic and lumbar vertebral body lesions.

4:42 PM; Abstract No. 283 - Percutaneous CT-guided vertebral biopsies in children

Purpose: To investigate the technical success and safety of a standardised radiological antegrade primary gastrostomy insertion technique in children weighing 5 kg or less. Materials and Methods: A retrospective analysis of all gastrostomies inserted at a single centre over a ten year period between 2003 and 2013 recognized 596 patients undergoing antegrade gastrostomy insertion. Of these 25 patients weighing less than 5 kg were identified. The standardised technique for primary antegrade gastrostomy insertion included the use of a 9Fr Freka gastrostomy, general anaesthesia, biplane fluoroscopy and oral barium prior to the procedure to visualise the colon. Indications, patient characteristics, technical details and complications were recorded prospectively at the time of procedure using a proforma. Results: The mean age of the children weighing less than 5kg was 6 months, range (2-20m). 20 males, 5 females. Patients weighed from 3-5kg (mean 4.5kg). Antegrade gastrostomy insertion was successful in 24/25 patients with no major complications. The unsuccessful procedure was a result of hepatomegaly preventing a safe route for access to the stomach despite distension with air. 3 patients (13%) had minor complications. 2 exit site infections & 1 exit site leakage. All resolved without sequelae with conservative management. No deaths occurred within 30 days of procedure. The results are comparable to those in this centre for children weighing45kg and those in the published literature for gastrostomy insertion in children of all weights and ages. Conclusion: Some endoscopists and surgeons consider the lower limit of body weight to insert gastrostomies to be 10kg but gastrostomies can be inserted safely into smaller children. The results of this study suggest antegrade gastrostomy insertion in infants less tan 5kg is technically feasible and safe with comparable technical success and complication rates to radiological or endoscopic gastrostomy insertion in larger children.

Core Needle Biopsy of Spinal Lesions under CT Guidance: Review of 79 Cases

The authors report the results of a retrospective study about computed tomography (CT)-guided percutaneous vertebral biopsies in 79 cases (44 males and 35 females, aged from 6 to 84 years old). Five biopsies were performed at the cervical level, 31 at the thoracic, 30 at the lumbar, and 13 at the sacrum. A diagnosis was obtained in 75 out of the 79 patients. Diagnostic yield was 95%, and diagnostic accuracy was 97.3%. Core needle biopsy under CT guidance for spinal lesions is a fast, relatively simple, minimally invasive, and low-cost method, with high levels of diagnostic accuracy and few complications. It plays a major role in the correct diagnosis and therapeutic planning. CT guidance allows safe and accurate biopsy of osseous lesions throughout the spine, obviating invasive open biopsy in most cases.

Establishing the diagnosis of tuberculous vertebral osteomyelitis

The aim of this article has been to analyze the clinical and radiological data suggesting tuberculous vertebral osteomielitis (TVO), and then discuss the steps to be followed to achieve an aetiological diagnosis. A thorough literature search was carried out to identify the best clinical and microbiological evidence for a fast and efficient diagnosis of TVO. The clinical and radiological diagnosis of spinal tuberculosis suffers from serious limitations, with a high percentage of cases requiring vertebral biopsy to reach a definitive diagnosis. The increasing incidence of multidrug-resistant tuberculosis has highlighted the insufficiency of the histopathological diagnosis and the need for microbiological diagnosis. Unfortunately, the maximum sensitivity of spinal tuberculosis cultures is 80 %, and traditional methods require 6 to 8 weeks for the isolation, identification and sensitivity study. New culture media and identification methods have improved sensitivity and reduced the time required for the identification. Molecular methods have now been integrated into a single test, with identification of the mycobacterium responsible and its sensitivity to rifampicin. Additionally, multiplex-PCR tests have been developed that allow a rapid differential diagnosis between granulomatous spondylodiscitis. All patients with subacute inflammatory back or neck pain showing suggestive radiological findings should be studied to rule out TVO. If there is no clear evidence of tuberculosis from another location or indication for surgery, a percutaneous vertebral biopsy should be performed. When TVO is suspected, all spinal or paravertebral tissue samples should be sent simultaneously to pathology and microbiology laboratories for appropriate processing.

C-arm Fluoroscopic Cone Beam CT for Guidance of Minimally Invasive Spine Interventions

Background: Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for near real time 3-D volume imaging guidance of percutaneous interventional procedures. In combination with digital flat panel detectors, CBCT has high spatial resolution with isotropic voxel size, allowing for high resolution image reconstruction in any plane, including 3D rotational reconstructions. CBCT combines the advantages of conventional CT imaging guidance with the improved spatial resolution, patient positioning, and access of fluoroscopy. Objective: The aim of this study is to demonstrate the advantages of CBCT over conventional CT and biplane fluoroscopy for imaging guidance of minimally invasive spinal and paraspinal interventional procedures. Methods: Five patients referred to the department of interventional neuroradiology for percutaneous spinal or paraspinal interventional procedures were intraoperatively evaluated with CBCT to assist in guidance of instrumentation placement. Procedures included transoral cervical vertebral biopsy, percutaneous thoracic vertebral biopsy, vertebroplasty, pelvic paraspinal/epidural abscess drainage, and paraspinal fiducial marker placement for treatment of osteoid osteoma. Results: All procedures were successfully performed with satisfactory diagnostic yield or therapeutic effect without procedure-related complications. Conclusion: Isocentric C-arm fluoroscopic cone beam CT (CBCT) is a new technique for 3D volume imaging guidance of interventional procedures of the spine with the capability to produce near real time high resolution image reconstructions in any plane. Compared to conventional CT and biplane fluoroscopy, CBCT offers improved anatomic visualization allowing high accuracy instrumentation placement, improving procedure results and minimizing risk of complications. Key words: Vertebroplasty, kyphoplasty, biopsy, computed tomography, CT, fluoroscopy, Carm, percutaneous, interventional radiology, imaging guidance

Reliability, Sensitivity, Specificity and Safety of Computed Tomography-guided Percutaneous Vertebral Biopsies

Purpose This is a retrospective study of the role played by computed tomography (CT)-guided percutaneous vertebral biopsy (PVB) in the study of focal spinal cord lesions. The aim was to analyze sample size sufficiency, adequacy of the biopsy, sensitivity and specificity of the diagnosis and last but not least the safety of the procedure. Materials and methods Inclusion criteria: diagnostic presumption of neoplasm or infection, focal spinal cord lesion, performance of a CT-guided PVB (ELSCINT 2400 Elect scanner purchased in 1993) and clinical/radiological followup for at least one year post puncture. Between February 1993 and February 2001 (8 years) CT-guided PVB was carried out in 236 consecutive patients, 14 of whom were rejected for various reasons (n = 222). Mean age was 57.9 years (range:6-8);119 were male (54%) and 103 female (46%). Location: 82% thoracolumbar spine, 11% sacrum and 7% cervical spine. Results Sensitivity: 86%, specificity: 100%, positive predictive value: 100%, negative predictive value: 14.3%, diagnostic accuracy: 84.2%. Histological material was obtained for 217 patients (98%); in 207 of these (93%) the material was adequate for diagnosis and in 5 (2.2%) assessment was impossible. In 187 patients (84.2%) the final diagnosis matched the result of PVB and in 30 (13.5%) this was not the case. In 5 patients (2,2%) no diagnosis was reached.The most frequent diagnoses were vertebral metastasis (69 patients, 31%) and culture-positive infection (51 patients, 23%). In 150 cases (68%) PVB turned out to be the key diagnostic factor. None of the 222 patients had a major or severe complication resulting from PVB. Minor complications were of two kinds: a) patient-related (4 vagal reactions, one subcutaneous hematoma and an allergic reaction, and b) technique-related (3 instances of needle breakage, with extraction being possible in all cases). A telephone-call based post-puncture pain evaluation was conducted in 40 consecutive patients at 24-48 hours. No significant repercussions were reported. Conclusion CT-scan guided PVB is a reliable, sensitive, specific and safe technique for diagnosing focal spinal cord lesions.

Development of a New Support Method for Transpedicular Punctures of the Vertebral Body: The Isocenter Puncture Method

Recently, the percutaneous transpedicular puncture of vertebral body under fluoroscopic guidance using a singleplane or biplane C-arm radiographic system has gained acceptance for percutaneous vertebroplasty (PVP) and vertebral bone biopsy [1–4]. PVP is usually performed by bilateral transpedicular puncture to gain uniform distribution of the injected cement in the vertebral body. However, if the tip of the puncture needle is advanced to the midline of the vertebral body, PVP by unilateral transpedicular puncture can be achieved. The unilateral transpedicular approach has advantages over the bilateral transpedicular approach, such as reduction of procedure time, cost, and radiation exposure [5, 6]. However, advancing the needle to the midline under fluoroscopic guidance is technically difficult, as is vertebral bone biopsy of a small lesion in the vertebral body. Currently, the CT-guided approach is used for this purpose [7, 8]. To advance the puncture needle to the target in the vertebral body under fluoroscopic guidance, we developed a new puncture method called the isocenter puncture (ISOP) method using the isocenter of the C-arm radiographic system. The purpose of this paper is to describe the ISOP method and our initial clinical results. The ISOP Concept