0:00

So let's talk about spinal biopsies diving a

0:03

little deeper into this approach.

0:06

So it's important to understand what are the trajectories

0:09

that we can take?

0:11

So we talked about the pedicle is sort of nice pathway

0:14

that is between the lamina and

0:17

that transverse process of the spine that allows us

0:20

to move safely as like a bridge to the

0:23

vertebra.

0:24

Oftentimes sites are within the

0:27

vertebra and we can move nicely from the skin

0:30

through the soft tissues into the

0:33

pedicle and then transpically in to

0:36

the vertebra and multiple needle sizes whether

0:39

it's an 11 gauge or a 13 gauge needle.

0:42

Okay, nice appropriately Traverse this bridge by

0:45

this transpicular road and oftentimes

0:49

It is thought to be the preferred approach for triple biopsies when we're

0:52

thinking about the trans-pedicular route. It's particularly advantageous because

0:55

there are really no vassals of note

0:58

in this region. It really lowers the risk of seeding relative

1:01

to other approaches as well.

1:03

It minimize slippage because our needle itself

1:06

can actually be lodged directly

1:09

in this particular site.

1:11

And then Advanced slowly into the

1:14

vertebra.

1:15

So what's another route that we can take in addition to the transpendicular route?

1:19

Well, that one is the Superior or inferior Coastal

1:22

transverse Road.

1:24

And this is approach that's a little similar to the transpendicular approach but

1:27

one difference the needle actually

1:30

enters from either superiorly or inferiorly to

1:33

the axial plane. And what it is is in relation

1:36

to that cost or transverse joint, which

1:39

is between the rib tubercle and

1:42

the transverse elements tubercle.

1:46

And so this is one that you don't need to

1:49

drill so much partly because you're moving directly

1:52

through this off

1:55

axial plane when it comes to sort of

1:58

the trans-pedicular approach you're going through

2:01

bone that requires particularly aggressive

2:04

use of the Mallet or if you're using a drill

2:07

and you feel comfortable with that drilling through hard

2:10

bone to get through but in the case of this cost of transverse

2:13

Point, you're essentially moving through a joint.

2:16

Off axial access in order to enter into

2:19

the virtual body one of

2:22

the things of notice. It's important to understand what sort of

2:25

Hardware patient has if there's any spinal fusions or

2:28

a throw seas in general. This is something that

2:31

may not actually be appropriate given the nature

2:34

of diffusion the hardware that is preventing you from accessing this

2:37

app access cost to transverse joint.

2:40

You really need to have this gap

2:43

between the rib and the transverse process in order

2:46

to allow you the appropriate trajectory in

2:49

order to enter and choose this in order to get into the

2:52

vertebral body in question.

2:54

So when we think about the extra particular

2:57

route, this is an additional sign. So imagine you

3:00

have this lesion in the vertebral body. And so where the

3:03

two red circles are are the extra particular

3:06

regions. And so you're going almost parallel

3:09

just lateral to the transverse process

3:12

directly through the paraspinal soft

3:15

tissues muscle into the potable body.

3:18

We need to be mindful of what are the

3:21

anatomical structures in this region and as we'll talk about

3:24

in one of the cases today. The lumbar artery is

3:27

one that we want to keep in mind as I mentioned. This is

3:30

a approach that's a little bit more lateral and

3:33

in being more lateral we want to think about not just fun vessels,

3:37

but we want to think about nerves and

3:40

other things of nature that could cause neuropathies in

3:44

the case of nerves or active leading hematomas

3:47

in the case of the blood vessels.

3:50

So for us those are sort of the

3:53

three sites three

3:55

The transpendicular the extra particular and the

3:58

cost to transverse. So now when we're thinking about anterior lateral

4:01

lateral rounds in the cervical spine,

4:04

these are ones that are really not as often performed

4:07

by Interventional Radiologists, but they're important to keep

4:10

in mind and to know partly because we need

4:13

to know what can be done whether this is performed by

4:16

a neurosurgeons whether this is performed by our

4:19

ENT surgeons or by our neuro and

4:22

eventualists. It's something to keep in mind. This is

4:25

one of the more common biopsy approaches for the cervical

4:28

vertebral lesions of note. And so if a

4:31

patient is supine you can get to this through that

4:34

and to your lateral lateral approach most commonly

4:37

when we're dealing with the other approaches, they would have been

4:40

prone or semi-prone in nature. And so

4:43

this is one of the few positions trajectories where

4:46

we would have a patient in a supine position

4:49

in order to achieve the biopsy, but again, not one

4:52

that's particularly common in the hands of

4:55

most Diagnostic and Interventional radiologist, but one that we really need

4:58

to keep in mind and of course the trans all route is something

5:01

that is often performed by our surgical

5:04

colleagues and may be considered and so

5:07

if we're asked to biopsy a particular patient in knowing that this is

5:10

a route we could recommend that they be seen

5:13

by ENT surgery for example