5 Image-Guided Percutaneous Biopsy for Spinal Tumors

Zachary M. Wilseck, Adam A. Khan, Leanne Y. Lin, Joseph J. Gemmete, and Venu Vadlamudi

Abstract

Spinal tumors are commonly identified during workup for spinal pathology. Imaging, often multimodal and commonly utilizing magnetic resonance imaging (MRI), is key in the initial evaluation. Some spinal tumors such as hemangiomas and aneurysmal bone cysts may have characteristic features on imaging. Many others, benign and malignant, may be challenging to specify by imaging alone. In these cases, spine biopsy is often utilized and has largely replaced open surgical biopsy given advantages of safety and decreased invasiveness. Prior to spine tumor biopsy, review of imaging is critical for procedural planning. Spine biopsy can be performed with fluoroscopic and/or computed tomography (CT) guidance. For the highest cervical vertebrae, CT guidance is generally preferred. For the remaining cervicothoracic and lumbar vertebrae, fluoroscopic guidance is generally utilized and coned beam CT during fluoroscopically guided biopsy can be performed for additional needle position guidance/confirmation. On-site pathology is optimal to ensure sampling adequacy and yield. While complications are rare, the operator must be cognizant of the inherent risks of spine biopsy to optimize yield and limit complications.

Key words

vertebral biopsy - imaging guidance - percutaneous biopsy

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