Transpedicular biopsy of thoracolumbar spine

INTRODUCTION: Despite advanced diagnostic methods, biopsy of vertebral body remains to be a very important step in treatment of spinal pathologies. Aim of the study was to present experience with mini-open transpedicular biopsy of the vertebral bodies of the thoracolumbar spine in the circumstances of present trend of CT guided needle biopsy preference. MATERIAL AND METHODS: Standard surgical technique was used in obtaining samples in a group of 38 patients during 1996-2001. Indication for biopsy was to identify the etiology of pathological findings on plain films, CT scans or MRI. 21 patients were men and 17 women average age was 59 years (26-76). In 16 cases the biopsy was performed during posterior or combined approach, when spine was stabilized and decompressed, in 22 cases biopsy was done alone from minimal 3-5cm long midline incision, these patients were followed up for 3-6 years. All biopsies were performed in general anesthesia with average duration of 29 minutes. 5 patients were re-biopsied after CT guided needle biopsy performed in another institution, which resulted in inadequate sample collection. Biopsies were performed by 155 mm long trocar with outer diameter of 4.5mm, inner diameter of 3,5mm, providing adequate sample of tissue. RESULTS: The pathology was identified in all cases, second examination of the sample had to be done in one case (97.4%). Average duration of the procedure (29 min) and low radiation exposure (0.1-0.3 min) was reached. DISCUSSION: Although the technique is more invasive than percutaneous, it was not associated with any substantial morbidity, we did not experience any neurological or other complications. As other authors, who deal with spinal neoplasms, we consider the possibility of radical biopsy tract excision during following posterior surgery as very important. CONCLUSION: Based on our results we consider the mini-open fluoroskopic guided transpedicular biopsy with a 3.5-mm inner diameter trocar as safe and effective method of vertebral biopsy. Minimally invasive but still an open approach is advocated to obtain a representative tissue sample.