Of all the percutaneous image-guided biopsy procedures that can be performed along the spinal axis, cervical spine biopsy remains the most challenging of these procedures. Indeed, many operators are reluctant to perform cervical spine procedures due to the perceived risk of the procedure in an area where the anatomy may present barriers to safe lesion access. The relatively small size of the cervical vertebrae pedicles limits the traditional “shielded” transpedicular pathway to the vertebral body for tissue sampling.
The critical vascular structures of the neck, the carotid and vertebral arteries and the internal and external jugular veins, surround the anterior and lateral aspects of the cervical spine. These vascular structures, at initial inspection, may appear to prevent direct access to a vertebrae or intervertebral disk. Close proximity to other critical structures such as the lung apices, trachea, esophagus, thyroid gland and submandibular glands raises appropriate concerns for injury to these structures. The aerodigestive tract and adjacent glandular structures may also limit the access to the target lesion(s) within the cervical spine.