title: Fluoroscopy-guided intervertebral disc biopsy with a coaxial drill system.
abstract: OBJECTIVE
  Percutaneous biopsy of discitis-osteomyelitis is performed to isolate the causative microorganism and exclude alternative diagnoses. We compared drill-assisted and manual fluoroscopy-guided intervertebral disc biopsies with respect to conscious sedation requirements and histologic quality of obtained specimens.
  
  
  METHODS
  Medical records of all single-level, fluoroscopy-guided intervertebral disc biopsies supervised by one of two musculoskeletal radiologists between January 2010 and March 2015 were reviewed. Duration and cumulative medication doses required for each biopsy were recorded. Pathology reports were reviewed to determine whether the obtained specimens were adequate for histopathologic evaluation. Microbiology reports were reviewed to determine whether the causative organism was isolated from the biopsy specimen.
  
  
  RESULTS
  During the study period, 21 drill-assisted and 20 manual biopsies were performed. The median duration of conscious sedation for drill-assisted biopsies was 30 min (range, 17-40 min) compared with 39 min (range, 20-90 min) for manual biopsies (p < 0.01). Drill-assisted biopsies also required lower median cumulative doses of intravenous midazolam [2 mg (range, 0-5 mg) vs. 3 mg (range, 0-9 mg); p = 0.02]. All drill-assisted biopsy specimens were adequate for histopathologic evaluation. One manual biopsy specimen (5 %; 1/20) was inadequate for histopathologic evaluation owing to crush artifact. The microbiology yields of drill-assisted and manual biopsies were comparable [14 % (3/21) vs. 20 % (4/20); p = 0.62].
  
  
  CONCLUSIONS
  Fluoroscopically-guided intervertebral disc biopsies performed with drill assistance require less conscious sedation compared with manual biopsies and yield specimens that are adequate for histopathologic evaluation.
authors.affiliation: Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA. wallacea@mir.wustl.edu.
authors.forename: Adam N
authors.initials: AN
authors.lastname: Wallace
authors.affiliation: Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA.
authors.forename: Rafael A
authors.initials: RA
authors.lastname: Pacheco
authors.affiliation: Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
authors.forename: Ross
authors.initials: R
authors.lastname: Vyhmeister
authors.affiliation: Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA.
authors.forename: Anderanik
authors.initials: A
authors.lastname: Tomasian
authors.affiliation: Washington University School of Medicine, 660 South Euclid Avenue, Saint Louis, MO, 63110, USA.
authors.forename: Randy O
authors.initials: RO
authors.lastname: Chang
authors.affiliation: Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Saint Louis, MO, 63110, USA.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Jennings
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000295:instrumentation; D015299:Discitis / Q000473:pathology*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000473:pathology*; D015641:Radiography, Interventional / Q000379:methods*
keywords: Drill system; Intervertebral disc biopsy; OnControl; Percutaneous spine biopsy