Image-Guided Percutaneous Spinal Biopsy: CT or C-Arm Guidance?

Image-guided percutaneous spinal biopsy is a minimally invasive procedure for histopathological confirmation and/or microbiological assessment of spinal lesions. When considering image-guided percutaneous spinal biopsy, both computed tomography (CT) and C-arm guidance have their advantages and specific applications. CT provides high-resolution cross-sectional images, allowing for precise localization of lesions and thus, effective for biopsy of spinal lesions in complex anatomical locations (e.g., cervical and upper dorsal spine). However, patients may receive higher doses of radiation than those with C-arm. C-arm guidance offers continuous imaging, which can enhance needle placement accuracy and is typically associated with lower radiation exposure than CT. However, C-arm provides less detailed images compared with CT, especially for certain lesions, and can be more challenging for accessing certain spinal areas, especially in the presence of anatomical variations. The choice between CT and C-arm guidance often depends on the specific clinical scenario, the location of the lesion, and the preferences of the clinician. For lesions that are easily accessible (lumbar, lower dorsal spine) and require real-time monitoring, C-arm may be preferred. For deeper or more complex lesions, CT guidance often provides better visualization and accuracy. Ultimately, the decision should be tailored to each patient's needs and the expertise of the clinician. This review article aims to compare the use of CT and C-arm guidance in percutaneous spinal biopsy, focusing on their technical aspects, diagnostic accuracy, and safety profiles.