Biopsy of the Spine: Advances with CT, Review

Objectives: Discuss the advancement of the CT-guided biopsy of spinal lesions and evaluate the literature and implications for advance practice providers.

Robert and Ball were the first to describe percutaneous biopsy of the spine in 1935. Since that time, the CT-guided biopsy has advanced into an extremely effective procedure. The open surgical method is less favorable due to operative complications, risk of leakage, and contamination to nearby organs and tissues. Spinal lesion is often close to vital organs or can be deeply positioned; therefore, the risk of a biopsy is concerning. Nonetheless, with advances in imaging, especially the CT scan, biopsies once considered in difficulty locations are guided by needle placement using the CT.

The CT-guided biopsy of the spine or vertebra has been found to be a safe, accurate, and efficient procedure for obtaining spinal and paraspinal tissue samples. Another advantage of the CT-guided biopsy is that it is a minimally invasive outpatient procedure with a high-yield tissue diagnosis and it is the best option to an open biopsy. It is also used for the evaluation and management of spinal infections, primary and metastatic lesions of the spine.

Literature review: Katappuram et. al. completed a retrospective reviewed of 75 patients who underwent percutaneous spinal or paraspinal soft tissue biopsies from 1980-1987. Information obtained from the record was based on biopsy location, age, sex, location of the lesion, type of needle used, and imaging modality. Twenty 22/75 of the biopsies were metastatic disease; infection and primary neoplasm make up the additional. The study found a 69/75 accuracy base on needle biopsy and 96% accuracy based on diagnostic category. Metastatic disease had the highest diagnostic yield (96%), and benign, primary and fracture (82%). Females were found to have a better biopsy result than males: 97% vs. 86%. A larger biopsy needle vs. a smaller needle was found to yield a better result: 97% vs. 80 %. Radicular symptoms were the only complication reported in this study, but overall, the complication rate for CT-guided biopsy of the spine is low. In summary, percutaneous need biopsy was found to be safe, accurate, inexpensive, quick, and reliable procedure of diagnosing a variety of spinal lesions (1991).

Implications for the advanced practice provider: With an increase demand for minimally invasive procedure in the outpatient and hospital setting, the role of the interventional radiologist (IR) has increased significantly over the past ten years. This rapid growth, along with challenges in filling IR fellowships, has caused a demand for IR MD. According to Taylor et. al. (2012), this provided an opportunity for allied health professionals including nurse practitioners (NP) and physician assistants (PA) to answer the call of this complex specialty. Since the consultation to IR comes from different services, nurse practitioner s who are not directly employed in the IR can also play a role by coordinating referrals and educating patients on the reason for the procedure, which will promote patient satisfaction and enhance a positive clinic outcome.