 The patient was placed in a prone position. A radiopaque grid was placed over the patient’s mid back neck for needle localization. Using multidetector helical CT, axial 3 mm scans were obtained through the thoracic spine demonstrating osteolytic lesion in the T6-T7 vertebral body and disk space suspicious for osteomyelitis/diskitis as seen on the patient's recent MRI study.A trajectory was plotted into the T6-T7 vertebral bodies using a left transpedicular approach. The patient's back 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 T6 pedicle. An inner drill cutting needle was utilized to advance the coaxial Bonopty needle into the posterior lateral aspect of the T6 vertebral body projecting medially and inferiorly toward the disk space. Aspiration through the coaxial technique 13- gauge Bonopty needle yielded approximately 2 ml of viscous sanguinous fluid. Next, a 22-gauge x 15-cm Chiba needles was utilized to perform fine needle aspiration which yielded another 1 ml of serosanguineous aspirate. Finally, the inner bone cutting needle was utilized to obtain a core tissue biopsy. Therefore, 3 fine needle aspirations were performed with 20 and 22-gauge x 15-cm . The samples were placed in two vials mixed with normal saline to facilitate microbiology analysis. The sample was sent directly to microbiology for infectious analysis (viral /bacterial/fungal, and mycobacterial cultures).The coaxial needle was 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 fine-needle aspiration and core needle biopsy of the T6 vertebral body