Introduction: Percutaneous or semi-open needle biopsy is recommended to obtain histological or bacteriological diagnosis prior to definitive treatment of destructive vertebral lesions. The clinical efficacy of repeating biopsies when initial samples have been inconclusive has not been established. We have examined the accuracy of repeat biopsy in these cases.

Materials and Methods: 103 patients with destructive vertebral lesions underwent percutaneous trans-pedicular or open vertebral biopsy. Eighty-two were available for analysis, and in 33 (39%) the initial biopsy failed to establish a histological or microbiological diagnosis. Thirteen patients underwent a repeat biopsy. The remaining 20 patients underwent a definitive surgical procedure or were treated empirically.

Results: Repeat biopsy was inconclusive in six patients, two were confirmed as infection (one TB and one Staph Aureus) and five malignancy (four lymphoma and one chordoma).

There was no significant association between the type of biopsy (open or percutaneous), the vertebral level of the lesion or the use of adjuvant therapy in the malignant cases. As has already been shown from this unit, the commencement of ‘blind’ antibiotic therapy reduces the success of bacteriological culture but does not affect the histological appearance.

Conclusion: Repeat vertebral biopsy is indicated if the initial biopsy is inconclusive, especially if antibiotics have not been commenced or a diagnosis of lymphoma is suspected. It should be performed promptly so as not to compromise the definitive treatment.