title: Diagnostic Value of Biopsy Techniques in Lumbar Spondylodiscitis: Percutaneous Needle Biopsy and Open Biopsy.
abstract: OBJECTIVE
  The objective of this study was to evaluate and compare the diagnostic value of the open biopsy technique and the percutaneous biopsy techniques in lumbar spondylodiscitis.
  
  
  METHODS
  Between January 2004 and December 2009, we retrospectively reviewed the medical records of 57 patients with infectious lumbar spondylodiscitis. The etiologic diagnosis of the infectious spondylodiscitis was obtained by two methods. Of 57 cases, twenty-seven patients underwent open biopsy and thirty patients underwent percutaneous needle biopsy including computed tomography (CT) - guided and fluoroscopy-guided needle aspiration. All biopsies were performed by experienced two neurosurgeons and one interventional radiologist.
  
  
  RESULTS
  Of the 57 cases radiologically consistent with spinal infection, 29 (50.9%) biopsy specimens resulted in positive cultures and 28 (49.1%) returned negative cultures. According to the type of biopsy techniques, the culture-positive rate was higher (p=0.005) in the open biopsy group than the percutaneous needle biopsy group. 19 (70.4%) of 27 biopsy specimens were positive in the open biopsy group, and 10 (33.3%) of 30 biopsy specimens were positive in the percutaneous needle biopsy group. Furthermore, the open biopsy showed higher positive culture rate than the percutaneous needle biopsy in cases with administration of empirical antibiotics although there was no statistically significant (p=0.137).
  
  
  CONCLUSIONS
  Open biopsy should be considered for administration of organism-specific antibiotics for the successful treatment when percutaneous needle yield negative result. Furthermore, empirical antibiotics should be delayed until results of cultures unless the patient is severely septic, critically ill, neutropenic or neurologically compromised.
authors.affiliation: Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Kyoung Hyup
authors.initials: KH
authors.lastname: Nam
authors.affiliation: Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
authors.forename: Geun Sung
authors.initials: GS
authors.lastname: Song
authors.affiliation: Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: In Ho
authors.initials: IH
authors.lastname: Han
authors.affiliation: Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Byung Kwan
authors.initials: BK
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
authors.forename: Seung Heon
authors.initials: SH
authors.lastname: Cha
keywords: Biopsy; Diagnostic Techniques; Needle; Spondylodiscitis; Surgical