Fluoroscopy-guided transpedicular trocar biopsy of the spine--results, review, and technical notes

The purpose of this study was to evaluate the technique and value of fluoroscopy-guided percutaneous transpedicular trocar biopsy in obtaining diagnostic tissue from vertebral body lesions and to review the current literature. The bone cores from 32 patients who underwent 34 transpedicular Jamshidi trocar biopsies for lesions in the thoracic, lumbar and sacral spine were examined. All samples were examined macroscopically for length and breakage and microscopically for trabeculae, marrow, and artifacts. Each sample was graded for its value for histologic examination. The diagnostic accuracy was assessed by the patient's clinical course and follow-up examinations. In 30 (93.8%) of the 32 patients a confirmed diagnosis or exclusion of pathology could be made. In 31 (91.2%) of 34 biopsies the quality of the specimen was assessed as "excellent". Two (5.9%) specimens were "good" and one (2.9%) was "poor". There were two minor complications (5.9%). Transpedicular biopsy of the spine using a Jamshidi trocar with an internal diameter of 3.1 mm under fluoroscopic guidance can be performed safely and efficiently and provides suitable bone cores for histologic examination. A combined clinical, radiological and pathological approach to the lesions leads to an excellent diagnostic yield.