Abstract
Aim
The purpose of this study was to establish the diagnostic utility and spectrum of fluoroscopy guided percutaneous transpedicular biopsies of the thoraco-lumbar spine performed at our institution and to review some aspects regarding the diagnosis of spinal tuberculosis (TB).
Methods
A retrospective study was performed on a consecutive series of 48 patients who underwent fluoroscopy guided percutaneous transpedicular biopsies of the spine performed at our institution. Biopsy specimens were sent for microscopy, culture and sensitivity (MC&S) as well as for TB microscopy, culture and polymerase chain reaction (PCR) and for histology.
Results
There were 26 females and 22 males. The ages ranged from 23 to 79 years with a mean of 47 years. Fifteen biopsies were performed in the thoracic spine and 33 in the lumbar spine. A diagnosis was established in 83% of patients. The most common diagnosis, made in 58% of cases, was TB. The second most common diagnosis was metastatic disease, diagnosed in 15%. In 3 patients a diagnosis was made of concomitant TB and metastatic adenocarcinoma. No complications were encountered. Regarding the diagnosis of spinal TB we found that microscopy for alcohol and acid fast bacilli has a very low yield, with TB cultures, PCR and histology delivering a higher yield. TB PCR was also found to be positive in some cases where the TB cultures were negative which had implications for our institution's protocol regarding performance of TB PCR testing.
Conclusion
Fluoroscopy guided percutaneous transpedicular biopsies of the thoraco-lumbar spine is a safe and effective tool in the diagnostic work-up of a patient with a spinal lesion of uncertain cause. We recommend that in all cases specimens should be send for histology and bacteriological studies and if spinal TB is suspected samples should be sent for histology, MC&S and PCR.
NO DISCLOSURES
