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.
MR imaging showing contrast enhancement in the area of inflammation and risk structures such as the S1 nerve
Precise trajectory planning in the multiplanar view
Name: Dr. Pawel Szaro
Institution: Muscle-Skeletal Department of Radiology, Sahlgrenska University Hospital, Gothenberg (Sweden)
Patient age and sex: 49 years, female
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.