bone biopsy

[mehul_25]

One of my ortho spine guys asked me if I do vertebral body biopsies. he was looking for a C6 or 7 pedicular biopsy. Anyone do these or have any comments?

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[lobelsteve]

One of my ortho spine guys asked me if I do vertebral body biopsies. he was looking for a C6 or 7 pedicular biopsy. Anyone do these or have any comments?

Technically it does not appear that difficult. As never having done one or seen one, I'll pass. DOes Fenton have a description? I'm guessing the MD Anderson folks see this kind of stuff.

 

[Tenesma]

hmmm... i'd punt it to IR under CT scan... i'd hate to bx the vertebral artery

 

[ampaphb]

hmmm... i'd punt it to IR under CT scan... i'd hate to bx the vertebral artery

why are you anymore likely to end up in the vert when doing a vertebral biopsy than when doing a vertebroplasty?

 

[ParaVert]

Ampa, if you're doing cervical vertebroplasty - you've got bigger balls than I do! Besides, cervical vertebroplasty is best done from an anterior-oblique (like cervical disco) or even trans-oral approach, not posterior transpedicular. Getting pedicle screws in the C-spine is dangerous and tough even with stereotactic guidance.

Would punt this to neurointerventional unless you have access and experience with CT guided cervical procedures.


That all being said, lumbar and thoracic vertebral bone biopsies are a piece of cake.

 

[ampaphb]

Ampa, if you're doing cervical vertebroplasty - you've got bigger balls than I do! Besides, cervical vertebroplasty is best done from an anterior-oblique (like cervical disco) or even trans-oral approach, not posterior transpedicular. Getting pedicle screws in the C-spine is dangerous and tough even with stereotactic guidance.

Would punt this to neurointerventional unless you have access and experience with CT guided cervical procedures.


That all being said, lumbar and thoracic vertebral bone biopsies are a piece of cake.

Nope - didn't realize it was cervical - completely agree with the consensus - punt!

 

[Tenesma]

anybody who does trans-oral vertebroplasty has got a lot of cojones - just think of the oral flora entering the vertebral body - yuck!

Josh Hirsch published a good case on a C2 vertebroplasty i think...

 

[mehul_25]

I deferred... I was just curious to see if anyone else has done it. Interestingly, IR passed too...that is how the question got asked of me.

 

[lobelsteve]

I deferred... I was just curious to see if anyone else has done it. Interestingly, IR passed too...that is how the question got asked of me.

WHy dosn't the surgeon get you the exposure via an anterior approach, and you just grab a chunk with the biopsy needle?