Transpedicular Vertebral biopsy: Navigated Biopsy technique Improvisation with Integrated Operation Theater Spine Suite (IOTSS)

Symptomaticvertebral and disco-vertebral lesions are often detected radiologically but arediagnosed with variable accuracy ranging from 95% for lytic lesions to 42%for mixed pathologies. Management of spinal lesions depends largely onhighly specific modalities like biopsy and histopathology. The firstever transpedicular(TP) biopsy(TPB) was performed by Stringham et al in 1994. Pedicle has been used as a gateway to vertebral body either via open orminimally invasive methods owing to our understanding of vertebral anatomy andexperience with TP fixation. Despite emerging techniques, sample inadequacy remains themost important factor that necessitates the need for a repeat biopsy. The TPB hasa diagnostic accuracy ranging from 75% -90% in both CT guidedradio-diagnostic centre biopsy as well as percutaneous biopsy in operationtheatre. Presenting here in this article is an add on technique as amodification to enhance the quality and quantity of sample obtained by usinga biopsy cannula, thereby increasing the diagnostic yield of TPB, in turnguiding towards an appropriate line of management. The authors have utilized the similar cannula that wasused for the percutaneous continuous drainage (PCD-2014) of psoas abscess andTPB( 2009). These conventional techniques were pioneered by Dr Bharat R Dave and has contributed immensely to thepatient diagnosis and treatment nationally and practiced by spine surgeons ondaily basis now .

Objective***:***

Theprimary objective of the present study is to add additional techniquemodification of biopsy in spine specifically with IOTS to get quality samplesin precious biopsy, soft material biopsy or a hard sclerotic lesion. Theobjective is to describe the technical steps in achieving it supported bypictures and images acquired in one patient already operated.