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* Date : 06-08-2009 - 07:47 PM (5435 days ago),
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A modified vertebroplasty approach for spine biopsies.
Fine-needle aspiration of the disk space has been utilized as a diagnostic tool in cases of suspected diskitis; however, the small-caliber needles used for fine-needle aspiration generally do not allow for sampling of the adjacent vertebrae.1 Furthermore, viscous infected fluid can be difficult to aspirate, and larger needles are difficult to maneuver without injuring the exiting nerves. As a consequence, fine-needle aspiration of disk space infections frequently fails to provide an adequate sample for analysis.
As practitioners have become more facile with percutaneous vertebroplasty, the transpedicular approach used for vertebroplasty has become more common for disk space biopsies. This technique allows for larger 11-gauge bone biopsy needles to be placed into the vertebral body and coaxial aspiration can be performed. The traditional transpedicular vertebroplasty approach, however, generally places the needle in a horizontal plane, making access to the disk space and adjacent vertebral bodies impossible. To obtain improved access to the disk space and adjacent endplates, we use the modified vertebroplasty approach described above for most cases of suspected diskitis/osteomyelitis. We employ this approach whenever possible on all suspected thoracic and lumbar disk space infection biopsies. The exception is when the patient’s anatomy precludes this approach—the most common being the lumbosacral interspace, where the anatomy occasionally is such that not enough oblique cephalad angulation can be obtained to angle through the disk space. Also, in obese patients with large body habitus, we may have to utilize an alternative more direct approach because of needle length limitations.
During a 6-month period we have used this technique in 5 patients with suspected spine infections, including the case described in this report. Three of the 5 cases yielded adequate samples and isolation of an organism. In the 2 cases where an organism was not obtained, long-term antibiotic therapy had been instituted before biopsy. Therefore, a definitive diagnosis in these patients would have likely been compromised regardless of the technique employed. We have not experienced any procedure-related complications by using this transpedicular transdiskal approach. This technique is also useful in noninfectious cases where an abnormality is present in the inferior aspect of a vertebral body. The pedicle in the vertebral level below the abnormality can be entered by using the same technique and the normal disk can be traversed. As long as strict attention to sterile technique is maintained, such an approach is a safe and effective way to obtain a tissue sample.
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