Symptomatic vertebral and disco-vertebral lesions are often detected radiologically but are diagnosed with variable accuracy ranging from 95% for lytic lesions to 42% for mixed pathologies. Management of spinal lesions depends largely on highly specific modalities like biopsy and histopathology. The first ever transpedicular(TP) biopsy(TPB) was performed by Stringham et al in 1994. Pedicle has been used as a gateway to vertebral body either via open or minimally invasive methods owing to our understanding of vertebral anatomy and experience with TP fixation. Despite emerging techniques, sample inadequacy remains the most important factor that necessitates the need for a repeat biopsy. The TPB has a diagnostic accuracy ranging from 75% -90% in both CT guided radio-diagnostic centre biopsy as well as percutaneous biopsy in operation theatre. Presenting here in this article is an add on technique as a modification to enhance the quality and quantity of sample obtained by using a biopsy cannula, thereby increasing the diagnostic yield of TPB, in turn guiding towards an appropriate line of management. The authors have utilized the similar cannula that was used for the percutaneous continuous drainage (PCD-2014) of psoas abscess and TPB( 2009). These conventional techniques  were pioneered by Dr Bharat R Dave and has contributed immensely to the patient diagnosis and treatment nationally and practiced by spine surgeons on daily basis now .

Objective:

The primary objective of the present study is to add additional technique modification of biopsy in spine specifically with IOTS to get quality samples in precious biopsy, soft material biopsy or a hard sclerotic lesion. The objective is to describe the technical steps in achieving it supported by pictures and images acquired in one patient already operated.