---
title: Re-biopsy of spine inflammation enabled using CAS-One IR
description: Transpedicular bone core biopsy with CAS-One IR in the upper sacrum for suspected inflammation visible on MRI, after failed first attempt in other hospital
---

 Wednesday, 8 December 2021

# Re-biopsy of spine inflammation enabled using CAS-One IR

Re-biopsy of spine inflammation enabled using CAS-One IR

2:39

 

Transpedicular bone core biopsy in the upper sacrum for suspected inflammation visible on MRI. Re-biopsy with CAS-One after failed first attempt in another hospital.

![Gothenburg_01a](https://www.cascination.com/hs-fs/hubfs/Gothenburg_01a.png?width=1240&name=Gothenburg_01a.png)

MR imaging showing contrast enhancement in the area of inflammation and risk structures such as the S1 nerve

 

![Gothenburg_03](https://www.cascination.com/hs-fs/hubfs/Gothenburg_03.png?width=1240&name=Gothenburg_03.png)

Precise trajectory planning in the multiplanar view 

 

---

**Name: **Dr. Pawel Szaro 

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**Institution:** Muscle-Skeletal Department of Radiology, [Sahlgrenska University Hospital](http://www.sahlgrenskaic.com/), Gothenberg (Sweden)

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**Patient age and sex: **49 years, female

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**Initial condition:**

- History of obesity and substance abuse (addiction)
- Thoracal Spondylodiscitis Th 6-7 in 2019 without signs of bacteria
- MRI control showed regression
- Complaints about pain in the lower back related to increased movement
- Neuropathic pain and little diffusion to the right leg
- Dyspnea difficulties and intermittent fever
- MRI shows onset of inflammatory changes in degenerated area S1 possibly caused by low-virulence spondylodiscitis
- Re-Biopsy planned with CAS-One for culture bacteria-specific PCR

---

**Treatment:** 

- Due to the transpedicular access necessary and the proximity to sensitive nerve pathways, the biopsy was performed with CAS-One IR. A previous attempt at another hospital had failed
- Enhanced 3D visibility of the pathways supported planning and avoidance of risk structures such as nerves and vertebral arteries
- CAS-One IR Aiming Device enabled highly accurate placement of the co-axial needle
- Intra-operative image fusion allowed the physicians to compensate for patient movement during procedure
- Biopsy of S1 was taken after the bone substance was too hard to penetrate
- After adaption to the new plan, the co-axial needle was placed through the left pedicle, lateral to the nerve
- The biopsy needle was successfully drilled into the S1 body and sufficient tissue for a biopsy was taken

---

**Conclusion** 

- Approximately 20mm of bone fragment was successfully extracted
- Further laboratory investigation is ongoing
- CAS-One IR allowed precise planning of the trajectory in areas that are difficult to access as well as tracking of the current needle position in the verification scans
- CAS-One IR helped to visualize a double-oblique needle trajectory. In this case, due to the hard bone pressure and the angle to the bone cortex. The process of free-hand drilling (or drilling without external support) can also lead to displacements
- CAS-One IR allowed fusion of previous MR images with the initial planning scan, to identify lesions that are not visible on the CT imaging

---

Learn more about the stereotactic navigation system [CAS-One IR](https://www.cascination.com/products/cas_one_ir?hsLang=en).

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