Percutaneous CT-Guided Vertebral Biopsy: A Technical Overview (anatomy, techniques, and clinical outcomes)

Percutaneous CT-guided vertebral biopsy has become the gold standard for the minimally invasive diagnosis of spinal lesions, offering a safe and effective alternative to open surgical biopsy. This procedure is essential for differentiating between primary bone malignancies, metastatic disease, and spondylodiscitis. Literature consistently demonstrates a high diagnostic accuracy range of 70% to 93%, which is heavily dependent on lesion type, needle selection, and proceduralist expertise. The primary clinical advantage of this technique lies in its significantly lower morbidity profile, reduced cost, and the ability to perform the procedure in an outpatient setting, often under local anesthesia. By utilizing the precision of computed tomography (CT), the interventionalist can navigate complex regional anatomy—such as the carotid sheath in the cervical region or the pleura in the thoracic region—while maintaining a direct path to the pathology. This review provides a technical roadmap for the spine interventionist, detailing anatomical safe zones, specific instrumentation mechanics, and level-specific procedural approaches required to maximize tissue yield and minimize complications.

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