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Utility Of Ct-Guided Needle Cervical Spine Biopsy In Non-Surgical Pathologies: Two Demonstrative Cases And A Review Of The Literature 2014

Category Interventional Brendan M. O'Shea, MD Bruno A. Policeni, MD Purpose Percutaneous biopsy of the spine is well established as an alternative to open surgical biopsy for diagnosis (1-4). Image guidance during biopsy of the cervical spine is critical for safety and diagnostic accuracy of spinal biopsy (1-3). Although CT-guided spinal biopsy (CTGSB) is well established, the majority of cases in the literature involve non-cervical levels. In a review of 410 consecutive patients undergoing CT-guided spinal biopsy, only 2% of interventions were performed on cervical lesions (1). We discuss two interesting cases at our institution where CTGB of the cervical spine during workup negated the need for open surgical biopsy or further surgical intervention. Materials & Methods A 24-year-old male smoker presented with neck stiffness and positional pain for 3 months. Initial workup included a cervical spine CT, which demonstrated a lytic lesion involving the C7 vertebral body with extension into the right pedicle. MRI demonstrated the lesion to be hyperintense on T2 and isointense on T1 with avid enhancement. Differential included giant cell tumor and chordoma. CT-guided needle biopsy was subsequently performed using an anterior transthyroidal approach. A 66-year-old male with history of T1N2b nasopharyngeal carcinoma initially treated with chemoradiation and subsequent neck dissection and repeat radiation presented with left neck pain and difficulty swallowing. PET scan was obtained and intense hypermetabolic uptake at C1 and C2 with associated erosive changes was seen. MRI demonstrated diffuse low T1 signal in the C2 vertebral body and right occipital condyle with avid enhancement. Findings were worrisome for radiation necrosis versus metastatic disease. CT-guided needle biopsy was performed using a posterolateral approach. Results Diagnostic specimens were obtained in both patients without complication. Final pathology in our two patients was Langerhans cell histiocytosis and radiation necrosis, respectively. The first patient was managed with conservative watching. The second patient had hyperbaric oxygen therapy initiated. Both patients were spared more invasive open surgical biopsy or excision. Conclusion CT-guided biopsy of the cervical spine provides a safe and effective method to obtain tissue diagnosis with less morbidity than open surgical biopsy. References 1. Lis, E. et al. Percutaneous CT-guided biopsy of osseous lesion of the spine in patients with known or suspected malignancy. AJNR 25, 1583–1588(2004). 2. Sun, H.Y, et al. Percutaneous Intervention of the C2 Vertebral Body Using a CT-Guided Posterolateral Approach. AJR 193, 1703–1705(2009). 3. Pua, U, et al. Percutaneous CT-Guided Biopsy of C3 Vertebral Body: Modified Approach for an Old Procedure. Cardiovasc Intervent Radiol 36, 880–882 2012). 4. Gupta, S. et al. Percutaneous Biopsy of Head and Neck Lesions with CT Guidance: Various Approaches and Relevant Anatomic and Technical Considerations. Radiographics 27, 371–390(2007).