This report demonstrates that a combined navigation-assisted and endoscopic approach allows safe biopsy and curettage of a pedicle lesion.The patient was a 17-year-old female.She had experienced lower back pain for 2 years.Magnetic resonance imaging (MRI) demonstrated a lesion extending from the posterior portion of the right L4 vertebral body to the lamina, showing low signal intensity on T1weighted images and mixed low and high signal intensity on T2-weighted images.(Figure 1A-C).Computed tomography (CT) revealed an osteolytic lesion extending from the right L4 pedicle to the vertebral body (Figure 1D andE).The differential diagnosis includes metastatic tumors, osteoblastoma, giant cell tumor, aneurysmal bone cyst, and infection.In the present case, imaging showed a solitary osteolytic lesion with a relatively well-defined margin, without obvious cortical destruction or a large soft tissue mass.In addition, wholebody CT revealed no evidence of a primary malignancy or other metastatic lesion.These findings suggested a low likelihood of malignancy.However, histological confirmation was required.Therefore, biopsy and curettage of the lesion were planned.As the lesion was localized in the pedicle, O-arm navigation (Medtronic, Minneapolis, MN, USA) and endoscopy (METRx system, Medtronic, Minneapolis, MN, USA) were used in
Dezawa et al. (Thu,) studied this question.