 The patient was placed in a prone position. A radiopaque grid was placed over the patient’s lower neck for needle localization. Using multidetector helical CT, axial 3 mm scans were obtained through the cervical spine demonstrating a left paraspinal mass adjacent to the T2 and T3 vertebral bodies. Additionally, the T2 vertebral body demonstrated diffuse marrow replacement on the prior MRI study and was to be targeted for biopsy.A trajectory was plotted into the T2 vertebral body using a left transpedicular approach. Subsequently, a parallel trajectory was plotted into the adjacent left paraspinal mass. The patient's neck was prepped with Betadine and draped in sterile fashion. The subcutaneous and deeper soft tissues were anesthetized with 1% lidocaine. A 13-gauge Bonopty needle was advanced into the posterior aspect of the left T2 pedicle. An inner drill cutting needle was utilized to advance the coaxial Bonopty needle into the posterior lateral aspect of the T2 vertebral body. A inner bone cutting needle was utilized to obtain a core bone biopsy from within this region of the vertebral body, placed in formalin, and sent directly to surgical pathology for diagnostic analysis. Subsequently, a 17-gauge x 9.9 cm coaxial needle was advanced into the soft tissue mass adjacent to the T2 vertebral body. An inner 18-gauge x 15 cm core biopsy needle was advanced with a 1 cm throw and 3 core biopsy samples were obtained. The samples were placed in formalin and sent directly to surgical pathology for diagnostic analysis. Final CT scanning demonstrated no evidence of hematoma, hemothorax or pneumothorax. Both coaxial needles were removed and adequate hemostasis was achieved with manual compression for 5 minutes. The patient tolerated the procedure well with no immediate complications. The patient remained neurologically at baseline at the end of the procedure. The patient was transferred back to the inpatient unit in stable condition.
Successful CT-guided core needle bone biopsy of the T2 vertebral body and core needle biopsy of left paravertebral soft tissue mass.