Image Guided Spine Biopsy

Your referring physician has requested a biopsy of a lesion in or around your spine. This procedure is typically performed in patients where there is a concern that cancer may have spread to the spine, developed in the spine, or to look for an infection. The following is a description of the procedure and the possible complications, so that you may provide informed consent before the procedure. The biopsy will be performed with image guidance with either fluoroscopy (x-ray) or CT (or CAT) scanner. The lesion will be located with the imaging, and then a needle will be placed into the lesion in order to obtain a specimen. You will be given intravenous (IV) sedation for the procedure which may make it difficult for you to remember much of the procedure, but you will NOT be put to sleep or on a ventilator/breathing machine. After the procedure, as long as there are no complications, you will be monitored for complications for a short time and then discharged to home with a driver. 

Spinal biopsy is a safe procedure and complications are uncommon, but they include: 

1. BLEEDING. As with all needle procedures, bleeding can occur. As long as you have no bleeding tendency and are not on any blood thinners such as Coumadin or Plavix, bleeding complications are extremely rare. Rarely, patients have had to undergo emergency surgery to relieve pressure on the nerve roots and spinal cord because of bleeding after spinal needle procedures.
2. INFECTION. Any needle through the skin can introduce infection. Infection is an extremely rare complication, and sterile technique will be used to minimize the risk. 
3. INJURY TO NERVES OR SPINAL CORD. The spine is associated with multiple nerves and the spinal cord, which can rarely be injured if the needle does not go where it is intended, particularly if the patient moves during the needle placement. A path for the biopsy needle which is least likely to cause such injury will be chosen. 
4. PNEUMOTHORAX. In certain locations, particularly biopsies of the thoracic spine (mid back), the lining of the lung can be punctured by the needle, which can cause air to leak out of the lung, then collect around the lung and cause compression of the lung itself. This lung compression is called a pneumothorax (or “collapsed lung”).  If a pneumothorax occurs, a small tube (chest tube) might need to be placed to drain out the air to re-expand the lung. Placement of a chest tube might cause admission to the hospital overnight. 
5. NONDIAGNOSTIC BIOPSY. Non-diagnostic result is not actually a complication, but it is the most common issue with spine biopsies. If possible, a small needle will be placed into the lesion so that a very small amount can be removed and then immediately be reviewed by a pathologist under a microscope during the procedure.  Sometimes the pathologist may say that they have enough material to provide an answer. However, in lesions of the spine, often more material is needed for an answer. Core specimens with larger needles may have to be obtained. These specimens often cannot be immediately examined by a pathologist, so the tissue obtained potentially might not be enough to give a diagnosis. However, we will not know until the final pathology report days later, which may unfortunately lead to a non-diagnostic result and possibly a repeat biopsy. Every attempt will be made to obtain adequate tissue for diagnosis on each biopsy. 

If you have any questions, please feel free to ask the physician performing the procedure prior to signing the consent.