Image-Guided Percutaneous Cervical Spine Biopsies: A Review of Techniques, Results, and Complication Avoidance

With bony and soft-tissue lesions of the spinal axis, tissue diagnosis is often required to institute appropriate management and therapy. Image-guided percutaneous spine biopsy is the diagnostic standard for tissue diagnosis of these lesions. Given the complex anatomy in and about the cervical spine, cervical spine biopsy can be quite challenging. We provide a retrospective review of image-guided percutaneous cervical spine biopsy procedures performed by a single experienced operator at our institution. All procedures were performed with CT-fluoroscopic guidance by using a coaxial needle technique. Eleven cases were reviewed along with their respective pathology and microbiology reports. Seven of the 11 biopsies were performed to evaluate potential neoplastic lesions, and 4 biopsies were performed due to a concern for infection. One of 7 patients (14.3%) required a repeat biopsy, which confirmed the initial diagnosis, and none of these patients required open biopsy. No procedure-related complications were encountered. CT fluoroscopy-guided percutaneous spine biopsy in the cervical spine with a coaxial needle technique is an invasive procedure that requires careful planning and performance to maximize patient safety and optimize the diagnostic yield. Recommendations for technical improvements and potential pitfalls of this procedure are also discussed.

Learning Objectives: 1) Identify the indications and contraindications for performing an image-guided percutaneous cervical spine biopsy. 2) Recognize the advantages of using a coaxial needle technique in performing image-guided percutaneous biopsies in the cervical spine. 3) Identify the key steps in preprocedural preparation for image-guided percutaneous biopsy at any level along the spinal axis.