Abstract
The results of fluoroscopically-guided closed needle (3.5-mm diameter) biopsies performed under general anaesthesia on 70 consecutive patients with lumbar spine pathology were reviewed. There were 36 men and 34 women with a mean age of 38 years. Sixty-four patients were Frankel-E, four were Frankel-D and two were Frankel-C.
The mean duration of the procedure (three tissue cores) was 17 minutes. Consultants performed 42% of the procedures and registrars the rest under supervision. All specimens were subjected to histological, cytological and microbiological evaluation. The results show a histological diagnostic yield of 88.57%. Of the 47 infective lesions, 34 were due to tuberculosis, three were pyogenic and 10 were reported as chronic non-specific inflammations.
In the 14 patients with neoplastic lesions, nine were metastatic and five were primary bone tumours. Histological diagnosis was inconclusive in six patients. Traction artefacts were noted in two patients with sclerotic lesions and one patient revealed normal bone. In tuberculosis, the culture was positive in only 29% of patients. The combined Lowenstein-Jensen and mycobacterial growth indicator tube media improved detection time and recovery rate of mycobacteria from smear negative specimens by 10%. The overall diagnostic yield for tuberculosis was 72.34%.
The diagnostic accuracy and safety of fluoroscopically-guided closed needle biopsy is comparable to that of CT scan and it is more cost effective. It should be an integral part of the management algorithm for spinal pathology.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at PO Box 47363, Parklands, Johannesburg 2121, South Africa.
