Transpedicular vertebral biopsy under O-arm navigation: a technical note

Abstract

Abstract Background Despite emerging techniques, sample inadequacy remains the most important factor that necessitates need for repeat biopsy. Transpedicular Biopsy has diagnostic accuracy ranging from 75 to 90% in both computed tomography guided or percutaneous C-arm guided biopsy. Presenting in this article is an add on technique as a modification to enhance quality and quantity of sample obtained using a self designed trocar cannula with computed tomography-based Navigation. Main body We have used transpedicular biopsy technique under C Arm fluoroscopy, previously, where we used a self-designed trocar and cannula in our study of 71 cases & reported an accuracy of 88.7% with no reported complications. This is add on modification of same technique where under 3D navigation, we introduce a pituitary forceps through a correctly positioned cannula. This helps for biopsy of soft lesions/ discal level pathologies. Also, multi-planar adjustment of cannula after initial Stealth O-Arm navigation helps in sampling of different regions of vertebral body by reinsertion of pituitary forceps with simple manipulation of cannula without withdrawal. This minimizes risk of fracturing pedicle. With our technical modification, cannulated drill bit with core opening can be drilled through cannula to retrieve a sample. Our technique has limitations being experience driven and also enabling technology dependent. However, same method can be applied using 2-dimensional fluoroscopy without navigation. Conclusion Our technique of using pituitary forceps through cannula is highly effective in getting adequate representative sample with spectrum ranging from hard sclerotic lesions to soft lesions and discal pathologies. This procedure can be used with traditional 2-dimensional fluoroscopy as well as with 3-dimensional navigated precision.