Vertebral Biopsy and Vertebrectomy

Illustration of a vertebral corpectomy, with a vertebral body and adjacent discs removed
Corpectomy, removal of a vertebral body with the adjacent discs. Image by BruceBlaus, Wikimedia Commons, CC BY-SA 4.0.

Indications

  • Biopsy for suspected spinal tumour, indeterminate lesion, or vertebral osteomyelitis without a culture result
  • Vertebrectomy for tumour with cord compression or instability, including solitary metastasis or primary sarcoma
  • Unstable burst fracture with canal compromise and neurological deficit
  • Vertebral osteomyelitis with abscess, collapse or progressive neurology
  • Rigid kyphosis needing vertebral column resection

Position

  • Prone for CT guided transpedicular biopsy and posterior vertebrectomy
  • Jackson frame with abdomen free for posterior surgery
  • Lateral decubitus for thoracotomy and retroperitoneal approaches

Operative Steps

  1. Plan the biopsy tract with the surgeon who will perform definitive resection, so the tract can be excised en bloc
  2. Refer suspected primary sarcoma to the treating sarcoma centre before any biopsy
  3. Use a transpedicular route for vertebral body lesions, which keeps tumour within the pedicle and avoids contaminating the paraspinal space
  4. Send histology plus aerobic, anaerobic, mycobacterial and fungal cultures
  5. Take cultures before antibiotics in the stable patient with suspected infection
  6. Embolise hypervascular tumours, such as renal and thyroid metastases, before resection
  7. Choose the approach. Posterior transpedicular reaches all levels, anterior gives direct body access, and lateral extracavitary combines both
  8. Record baseline SSEP and MEP and maintain mean arterial pressure for cord perfusion
  9. Posterior route. Place pedicle screws two levels above and below, laminectomy, then ligate the thoracic nerve root as needed
  10. Excise the body piecemeal, remove adjacent discs, and prepare endplates. Protect the dura with a malleable retractor
  11. Reconstruct with an expandable titanium cage or structural strut graft (fibula or iliac crest), plus cement in tumour
  12. Contour rods, compress, confirm dural decompression and close over a drain

Postoperative Care

  • Neurological observations hourly, with urgent MRI for any new deficit
  • Early mobilisation with bracing guided by stability, and venous thromboembolism prophylaxis
  • Adjuvant radiotherapy or antimicrobial therapy guided by histology and culture

Complications

  • Cord or root injury, with neuromonitoring change as the early warning
  • Massive bleeding from epidural veins or hypervascular tumour
  • Dural tear and cerebrospinal fluid leak
  • Cage subsidence, migration or rod failure
  • Pneumothorax after thoracic biopsy, and great vessel or thoracic duct injury in anterior approaches
  • Tumour seeding along the biopsy tract, and surgical site infection

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 20 October 2026.