Disc Aspiration/Biopsy

KEY FACTS

Terminology

• Fine-needle aspiration of intervertebral disc material ± core biopsy

Preprocedure

• Coagulopathy/anticoagulation studies

  • Prothrombin time, activated partial thromboplastin time, international normalized ratio

  • Hemoglobin, hematocrit, and platelet count

• Suspected osteomyelitis/discitis

  • To confirm infectious organism

Procedure

• For thoracic and lumbar levels use “Scotty dog” anatomy

  • Superimpose superior endplate of vertebra below disc to be intervened upon

  • Place “ear” of “Scotty dog” (superior articular process) at center of intervertebral disc by angling AP fluoroscopy plane toward desired side

  • Needle entry should be at junction of middle 1/3 and outer 1/3 of disc (in front of Scotty dog “ear”)

• CT guidance often preferred for cervical upper/mid thoracic disc aspiration/biopsies

  • Ensure patient can receive iodinated contrast if desired

Post Procedure

• Careful evaluation for new neurologic symptoms following procedure