Skip to main content
SpringerLink
Log in

Diagnostic and Therapeutic Percutaneous Transpedicular Approaches to the Spine

  • Chapter
Arthroscopic and Endoscopic Spinal Surgery

  • 894 Accesses

Abstract

Open biopsy advocates prefer transpedicular biopsy (TPB) because it maximizes tissue retrieval, thus providing the highest diagnostic success rate. Open biopsy is especially relied on after failed needle biopsy or in selected presumed primary bone or cartilaginous tumors (1). However, the complications and morbidity associated with an open surgical procedure provided incentive for the development of closed needle biopsy techniques.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Mirra JM, Eckardt JJ, Rosen G. Biopsy considerations, in Bone Tumors: Clinical, Radiologic and Pathologic Correlations (Picci P, Gold RH, eds.), Lea & Febiger, Philadelphia, 1989, pp. 31–34.

    Google Scholar 

  2. Kattapuram SV, Khurana JS, Rosenthal DI. Percutaneous needle biopsy of the spine. Spine 1992;17:561–564.

    Article  PubMed  CAS  Google Scholar 

  3. Kattapuramm SV, Rosenthal DI. Percutaneous biopsy of skeletal lesions. Am J Roentgenol 1991;157:935–942.

    Google Scholar 

  4. Metzger CS, Johnson DW, Donaldson WF. Percutaneous biopsy in the anterior thoracic spine. Spine 1993;18:373–378.

    Article  Google Scholar 

  5. Murphy WA, Destouet JM, Gilula LA. Percutaneous skeletal biopsy 1981: a procedure for radiologists—results, review and recommendations. Radiology 1981;139:545–549.

    PubMed  CAS  Google Scholar 

  6. Kattapuram SV, Rosenthal DI. Percutaneous needle biopsy of the spine, in Tumors of the Spine: Diagnosis and Clinical Management (Sundaresan N, Schmidek HH, Schiller Al, Rosenthal DI, eds.), WB Saunders, Philadelphia, 1990, pp. 46–51.

    Google Scholar 

  7. Robertson RC, Ball RP. Destructive spine lesions: diagnosis by needle biopsy. J Bone Joint Surg 1935;17:749–758.

    Google Scholar 

  8. Laredo JD, Bard M. Current status of musculoskeletal interventional radiology. Radiol Clin North Am 1994;32:377–398.

    PubMed  CAS  Google Scholar 

  9. Tehranzadch J, Freiberger RH, Glielman, B. Closed skeletal needle biopsy review of 120 cases. Am J Roentgenol 1983;140:113–115.

    Google Scholar 

  10. Fyfe IS, Henry APJ, Mulholland RC. Closed vertebral biopsy. J Bone Joint Surg (Br) 1983;65:140–143.

    CAS  Google Scholar 

  11. Kornblum MB, Wesolowski DP, Fischgrund JS, Herkowitz HN. Computed tomography-guided biopsy of the spine: a review of 103 patients. Spine 1998;23:81–85.

    Article  PubMed  CAS  Google Scholar 

  12. Stringham DR, Hadjipavlou A, Dzioba RB, Lander P. Percutaneous transpedicular biopsy of the spine. Spine 1994;19:1985–1991.

    Article  PubMed  CAS  Google Scholar 

  13. Roy-Camille R, Saillant G, Mamoudy P. Biopsie du corps vertebral par voie posterieure transpediculaire. Rev Chir Orthop 1983;69:147–149.

    PubMed  CAS  Google Scholar 

  14. Banta CJ, King AG, Dabezies EJ, Liljeberg RL. Measurement of effective pedicle diameter in the human spine. Orthopedics 1989;12:939–942.

    PubMed  Google Scholar 

  15. Berry JL, Moran JM, Berg WS, Steffee AD. A morphometric study of human lumbar and selected thoracic vertebrae. Spine 1987;12:363–367.

    Article  Google Scholar 

  16. Krag MH, Weaver DL, Beynnon BD, Haugh LD. Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine 1988;13:27–32.

    Article  PubMed  CAS  Google Scholar 

  17. Misenhimer GR, Peek RD, Wiltse LL, Rothman SLG, Widell EH. Anatomic analysis of pedicle cortical and cancellous diameter as related to screw size. Spine 1989;14:367–372.

    Article  PubMed  CAS  Google Scholar 

  18. Olsewski JM, Simmons EH, Kallen FC, Mendel FC, Severin CM, Berens DL. Morphometry of the lumbar spine: anatomical perspectives related to transpedicular fixation. J Bone Joint Surg (Am) 1990;72A:541–549.

    Google Scholar 

  19. Schmidek HH, Gomes FB, Seligson D, McSherry JW. Management of acute and stable thoracolumbar with and without neurologic deficit. Neurosurgery 1980;7:30–35.

    Article  PubMed  CAS  Google Scholar 

  20. Whitecloud TS, Skalley TC, Cook SD, Morgan EL. Roentgenographic measurement of pedicle screw penetration. Clin Orthop 1989;245:57–68.

    PubMed  Google Scholar 

  21. Zindrick MR, Wiltse LL, Doornik A, et al. Analysis of the morphometric characteristics of the thoracic and lumbar pedicles. Spine 1987;12:160–166.

    Article  PubMed  CAS  Google Scholar 

  22. Yamagata M, Hiroshi K, Shohei M, et al. Mechanical stability of the pedicle screw for the lumbar spine. Spine 1992;17:551–554.

    Article  Google Scholar 

  23. Greenfield RT, Grant RG, Bryant D. Pedicle screw fixation in the management of unstable thoracolumbar spine injuries. Orthop Rev 1992;6:701–706.

    Google Scholar 

  24. King AG, MacEwen GD, Bose WJ. Transpedicular convex anterior hemiepiphysiodesis and posterior arthrodesis for progressive congenital scoliosis. Spine 1992;17:S291–S294.

    Article  PubMed  CAS  Google Scholar 

  25. Steffee AD, Biscup RS, Sitowski DJ. Segmental spine plates with pedicle screw fixation: a new internal fixation device for disorders of the lumbar and thoracolumbar spine. Clin Orthop 1986;203:45–53.

    PubMed  Google Scholar 

  26. Steffee AD. Segmental spine plates with pedicle screw fixation. Clin Orthop 1986;103:45–53.

    Google Scholar 

  27. Olerud S, Karlstrom G, Sjostrom L. Transpedicular fixation of thoracolumbar vertebral fractures. Clin Orthop 1988;227:44–51.

    PubMed  CAS  Google Scholar 

  28. Roy-Camille R, Saillant G, Mazel CH. Plating of thoracic, thoracolumbar, and lumbar injuries with pedicle screw plates. Orthop Clin North Am 1986;17:147–159.

    PubMed  CAS  Google Scholar 

  29. Magerl FP. Stabilization of the lower thoracic and lumbar spine with external skeletal fixation. Clin Orthop 1984;189:125–141.

    PubMed  Google Scholar 

  30. Hardaker WT, Cook WA, Friedman AH, Fitch RD. Bilateral transpedicular decompression and Harrington rod stabilization in the management of severe thoracolumbar burst fractures. Spine 1992;17:162–171.

    Article  PubMed  Google Scholar 

  31. Patterson RH Jr, Arbit E. A surgical approach through the pedicle to protruded thoracic discs. J Neurosurg 1978;48:768–772.

    PubMed  Google Scholar 

  32. Duncan GA, Ferguson AB. Benign giant-cell tumor of the fourth lumbar vertebra: a case report. J Bone Joint Surg (Am) 1936;3:769–772.

    Google Scholar 

  33. Capener N. The evolution of lateral rachiotomy. J Bone Joint Surg (Br) 1954;36:173–176.

    Google Scholar 

  34. Michele JM, Krueger FJ. Surgical approach to the vertebral body. J Bone Joint Surg (Am) 1949;31:873–878.

    Google Scholar 

  35. Travaglini F. Tumours of the vertebral body: transpedicular biopsy with posterior surgical stabilization. Bull Hosp Joint Dis 1979;40:1–12.

    PubMed  CAS  Google Scholar 

  36. Stoker DJ, Kissin CM. Percutaneous vertebral biopsy: a review of 135 cases. Clin Radiol 1985:36:569–577.

    Article  PubMed  CAS  Google Scholar 

  37. Fidler MW, Niers BBAM. Open transpedicular biopsy of the vertebral body. J Bone Joint Surg (Br) 1990;72:884, 885.

    CAS  Google Scholar 

  38. Arya S, Crow WN, Hadjipavlou AG, Nauta HJW, Borowski AM, Vierra LA, Walser E. Percutaneous transpedicular management of discitis. JVIR 1996;7:921–927.

    PubMed  CAS  Google Scholar 

  39. Borowski AM, Crow WN, Hadjipavlou AG, Chaljub G, Mader J, Cesani F, vanSonnenberg E. Percutaneous management of pyogenic spondylodiscitis. AJR 1998;170:1587–1592.

    PubMed  CAS  Google Scholar 

  40. Hadjipavlou AG, Arya S, Crow WN, Maggio WW, Lander P, Nardone EM, Eyal A. Percutaneous transpedicular biopsy of the spine. J Intervent Radiol 1996;11:103–108.

    Google Scholar 

  41. Hadjipavlou AG, Crow WN, Borowski A, Mader JT, Adesokan A, Jensen R. Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis. Am J Orthop 1998;188–197.

    Google Scholar 

  42. Hadjipavlou AG, Kontakis GM, Gaitanis I, Katonis PG, Lander P, Crow WN. Effectiveness and pitfalls of percutaneous transpedicular biopsy of the spine. Clin Orthop 2003;411:54–60.

    Article  PubMed  Google Scholar 

  43. Hadjipavlou AG, Mader JT, Necessary JT, Muffoletto AJ. Hematogenous pyogenic spinal infections and their surgical management: Spine 2000;25:1668–1679.

    Article  PubMed  CAS  Google Scholar 

  44. Kambin P (ed). Arthroscopic Microdiscectomy: Minimal Intervention in Spinal Surgery, Williams & Wilkins, Baltimore, 1990.

    Google Scholar 

  45. Saillant G. Etude anatomique des pedicules vertebraux: application chirurgicale. Rev Chir Orthop 1976;62:151–160.

    PubMed  CAS  Google Scholar 

  46. Ball RP. Needle (aspiration) biopsy. J Tenn State Med Assoc 1934;27:203–207.

    Google Scholar 

  47. Ward JC, Jeanneret B, Oehlschlegel C, Magerl F. The value of percutaneous transpedicular vertebral bone biopsies for histologic examination: results of an experimental histopathologic study comparing two biopsy needles. Spine 1996;21:2484–2490.

    Article  PubMed  CAS  Google Scholar 

  48. Renfrew DL, Whitten CG, Wiese JA, el-Khoury GY, Harris KG. CT-guided percutaneous transpedicular biopsy of the spine. Radiology 1991;180:574–576.

    PubMed  CAS  Google Scholar 

  49. Hsu WC, Lim KE. Computed tomography-guided percutaneous transpedicular biopsy of the thoracic spine. Chang Gung Med J 2001;24:368–375.

    PubMed  CAS  Google Scholar 

  50. Jho HD. Endoscopic microscopic transpedicular thoracic discectomy: technical note. J Neurosurg 1997;87:125–129.

    Article  PubMed  CAS  Google Scholar 

  51. Minart D, Vallee JN, Cormier E, Chiras J. Percutaneous coaxial transpedicular biopsy of vertebral body lesions during vertebroplasty. Neuroradiology 2001;43:409–412.

    Article  PubMed  CAS  Google Scholar 

  52. Moller S, Kothe R, Wiesner L, Werner M, Ruther W, Delling G. Fluoroscopy-guided transpedicular trocar biopsy of the spine—results, review and technical notes. Acta Orthop Belg2001;67(5):488–499.

    PubMed  CAS  Google Scholar 

  53. Pierot L, Boulin A. Percutaneous biopsy of the thoracic and lumbar spine: transpedicular approach under fluoroscopic guidance. Am J Neuroradiol 1999;20:23–25.

    PubMed  CAS  Google Scholar 

  54. Ashizawa R, Ohtsuka K, Kamimura M, Ebara S, Takaoka K. Percutaneous transpedicular biopsy of thoracic and lumbar vertebrae—method and diagnostic validity. Surg Neurol 1999;52(6):545–551.

    Article  PubMed  CAS  Google Scholar 

  55. Jelinek JS, Kransdorf MJ, Gray R, Aboulafia AJ, Malawer MM. Percutaneous transpedicular biopsy of vertebral body lesions. Spine 1996;21:2035–2040.

    Article  PubMed  CAS  Google Scholar 

  56. Dagirmanjian A, Schils J, McHenry M, Modic MT. MR imaging of vertebral osteomyelitis revisited. Am J Roentgenol 1996;167:1539–1543.

    CAS  Google Scholar 

  57. Ambrose GB, Alpert M, Neer CS. Vertebral osteomyelitis: a diagnostic problem. JAMA 1966;197:619–622.

    Article  PubMed  CAS  Google Scholar 

  58. Waldvogel RA, Papageorgiou PS. Osteomyelitis: the past decade. N Engl J Med 1980;303:360–370.

    Article  PubMed  CAS  Google Scholar 

  59. Ottolenghi CE. Aspiration biopsy of the spine: technique for the thoracic spine and results of twenty-eight biopsies in this region and overall results of 1050 biopsies of other spinal segments. J Bone Joint Surg 1969;51A:1531–1544.

    Google Scholar 

  60. Post MJD, Sze G, Quencer RM, et al. Gadolinium enhanced MR in spinal infection. J Comput Assist Tomogr 1990;14:721–729.

    Article  PubMed  CAS  Google Scholar 

  61. Sklar EML, Post MJD, Lebwohl NH. Imaging of infection of lumbosacral spine. Neuroimaging 1993;3:577–590.

    Google Scholar 

  62. Wisneski RJ. Infectious disease of the spine: diagnostic and treatment considerations. Orthop Clin North Am 1991;22:491–501.

    PubMed  CAS  Google Scholar 

  63. Eismont FJ, Bohlman HH, Soni PL, et al. Pyogenic and fungal vertebral osteomyelitis with paralysis. J Bone Joint Surg 1983;65A:19–29.

    Google Scholar 

  64. Emery SE, Chan DP, Woodward HR. Treatment of hematogenous pyogenic vertebral osteomyelitis with anterior debridement and primary bone grafting. Spine 1989;14:284–291.

    PubMed  CAS  Google Scholar 

  65. Estherhai JL Jr, Gelb I. Adult sepric arthritis. Orthop Clin North Am 1991;22:503–514.

    Google Scholar 

  66. Krodel A, Sturz H, Siebert CH. Indication for and results of operative treatment of spondylitis and spondylodiscitis. Arch Orthop Trauma Surg 1991;110:78–82.

    Article  PubMed  CAS  Google Scholar 

  67. Lane JG, Falahaee MH, Wojtys EM, et al. Pyarthrosis of the knee: treatment considerations. Clin Orthop 1990;252:198–204.

    PubMed  Google Scholar 

  68. Lee TC, Lu K, Yang LC, Huang HY, Liang CL. Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar spine tuberculosis with early stage bone destruction. J Neurosurg 1999;91:163–169.

    PubMed  CAS  Google Scholar 

  69. Taylor TKF, Dooley BJ. Antibiotics in the management of postoperative disc space infections. Aust NZ J Surg 1978;48:74,75.

    Google Scholar 

  70. Jackson RW. The septic knee arthroscopic treatment. Arthroscopy 1985;1:194–197.

    Article  PubMed  CAS  Google Scholar 

  71. Ivey M, Clark R. Arthroscopic debridement of the knee for septic arthritis. Clin Orthop 1985;199:201–206.

    PubMed  Google Scholar 

  72. Gebhard JS, Brugman JL. Percutaneous discectomy for the treatment of bacterial discitis. Spine 1994;19:855–857.

    Article  PubMed  CAS  Google Scholar 

  73. Onik G, Shang Y, Maroon JC. Automated percutaneous biopsy in postoperative diskitis: a new method. AJNR 1990;1:391–393.

    Google Scholar 

  74. Vu WY, Siu C, Tong PC, et al. Percutaneous suction aspiration for osteomyelitis: report of two cases. Spine 1991;16:198–202.

    Article  Google Scholar 

  75. Fraser RD, Osti OL, Vernon-Roberts B. Iatrogenic discitis: the role of intravenous antibiotics in prevention and treatment: an experimental study. Spine 1989;14:1025–1032.

    Article  PubMed  CAS  Google Scholar 

  76. Lucio E, Adesokan A, Hadjipavlou AG, Crow WN, Adegboyega PA. Pyogenic spondylodiskitis. Arch Pathol Lab Med 2000;124:712–716.

    PubMed  CAS  Google Scholar 

  77. Garcia A, Grantham SA. Hematogenous pyogenic vertebral osteomyleitis. J Bone Joint Surg 1960;42A:429–436.

    Google Scholar 

  78. Sapico FL, Montgomerie JZ. Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis 1979;1:754–756.

    PubMed  CAS  Google Scholar 

  79. Frederickson B, Yuan H, Olans R. Management and outcome of pyogenic vertebral osteomyelitis. Clin Orthop 1978;131:160–167.

    PubMed  Google Scholar 

  80. Guven O, Yalgin S, Karahan M, Esemenli T. Transpedicular drainage of Pot’s abscess: a report of two cases. Am J Orthop 1995;24:421–425.

    PubMed  CAS  Google Scholar 

  81. Crow WN, Borowski AM, Hadjipavlou AG, Walser EM, Arya S, Calme MB, Amps J, Jensen R, Somisetty S, Alford B, Adesokan A. Percutaneous transpedicular automated nucleotomy for debridement of infected discs. JVIR 1998;9:161–165.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Crete, Crete, Greece

    Alexander G. Hadjipavlou MD (Professor of Orthopedics Surgery-Traumatology), George M. Kontakis MD (Assistant Professor of Orthopaedics-Traumatology), Ioannis Gaitanis MD (Orthopaedic Surgeon) & Michael Tzermiadianos MD (Orthopedic Surgeon)

Authors
  1. Alexander G. Hadjipavlou MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George M. Kontakis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ioannis Gaitanis MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michael Tzermiadianos MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Drexel University College of Medicine, Philadelphia, PA

    Parviz Kambin MD (Professor Orthopedic Surgery and Endowed Chair of Spinal Surgery) (Professor Orthopedic Surgery and Endowed Chair of Spinal Surgery)

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Hadjipavlou, A.G., Kontakis, G.M., Gaitanis, I., Tzermiadianos, M. (2005). Diagnostic and Therapeutic Percutaneous Transpedicular Approaches to the Spine. In: Kambin, P. (eds) Arthroscopic and Endoscopic Spinal Surgery. Humana Press. https://doi.org/10.1385/1-59259-904-4:167

Download citation

  • DOI: https://doi.org/10.1385/1-59259-904-4:167

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-522-4

  • Online ISBN: 978-1-59259-904-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation