Radiology - A guide to your Image Guided Spinal Biopsy

What is an image guided spinal biopsy and why do I need one?

An image guided spinal biopsy is a test during which a special needle is passed through the skin to take a tiny sample of bone or other tissue from an area inside the body. The radiologist will use CT or live imaging (fluoroscopy) to guide the needle to the abnormal tissue. The sample is then looked at under the microscope for a diagnosis.

Who has made the decision?

The consultant in charge of your care feels that this is the best way of getting more information about your problem. We usually plan a biopsy in advance, so you have the opportunity to discuss your options with your consultant or their team. Your opinion will be taken into account. If you do not want this procedure, you can decide not to have it at any time, even after signing the consent form.

How do I prepare for the biopsy?

If you are not already an inpatient, you will be admitted to a ward on the day of your biopsy. You will be looked after by the nurses on the ward who will take some observations and blood tests before hand to check that you do not have an increased risk of bleeding. If you are taking any medication that can thin your blood such as warfarin, aspirin or clopidogrel. Please contact the department you are to attend as this medication will need to be stopped in advance. You must not eat anything for 6 hours before your biopsy. You can have a few sips of clear fluid (water) up to 2 hours before the biopsy.

What happens during an image guided spinal biopsy?

You will be brought to the x-ray department to have your biopsy. The radiologist (the doctor who will perform your biopsy) will speak to you beforehand and answer your questions. Please let them know if you are allergic to anything. The skin over the area of the biopsy will be cleaned with an antiseptic and covered with a sterile drape. The procedure will be performed under a local anaesthetic injection and in some cases sedative drugs through a drip. The local anaesthetic will sting initially, before the skin goes numb. The sedation is designed to relax you and help manage any pain but is not an anaesthetic and you will be conscious throughout the procedure. The doctor will use imaging to guide the needle to the abnormal tissue or bone. You will need to stay still throughout the procedure. You may feel some discomfort or pressure as the biopsy is taken. The procedure takes approximately 30-60 minutes from start to finish.

What are the risks and complications?

An image guided biopsy is a safe procedure and serious complications are rare. Small risks vary depending on where the biopsy is taken from. Despite these small risks your consultant has decided to refer you for the examination. This is because they feel that the benefits of having the biopsy outweigh the risks of having it done. Your consultant or one of their will discuss your options with you in advance. The risks include the following:

• Discomfort or mild pain in the area where the biopsy was taken is possible. This can usually be controlled with painkillers
• Bleeding is usually minimal and of short duration but more serious bleeding can rarely occur. If the bleeding continues, then it is possible that you might need a blood transfusion. Very rarely, an operation or another procedure is required to stop the bleeding
• Infection of the skin or deeper tissue is rare
• Injury of surrounding structures. As the biopsy is from your spine there is a very small risk of damaging the adjacent nerve that comes from the spine close to the biopsy site.

If you have any worries, please do not hesitate to discuss possible complications or risks with the hospital staff before your biopsy. Unfortunately, some biopsies fail to give an answer. In this case, you may need the procedure to be repeated.

After the biopsy

You will be taken back to the ward where you need to rest in bed for a few hours. The nurses will check you blood pressure and pulse regularly to make sure that there are no problems. Some patients may experience pain following the procedure. Please let the nurses know if you have any pain and the may be able to offer you some pain relief. You can eat and drink normally unless instructed otherwise by the doctor.

Going home

If the procedure is being carried out as a day case and there are no complications, you will be allowed home a few hours after the biopsy. You must not drive or use public transport. You must have an adult to take you home by car or taxi and stay with you overnight. If there is no one available to stay with you at home overnight, please let us know as a you will have to stay in hospital overnight.

When will I get the results?

It takes about two weeks for the results to come back. These will be sent to the consultant who asked for you to have the biopsy and they will contact you.

Could you be pregnant?

If there is any chance you could be pregnant, please call 0161 2065091 if your appointment is at Salford Royal Hospital. Please call 0161 656 1178 if your appointment is at Royal Oldham Hospital.

Is x-ray guidance dangerous?

All x-ray machines use potentially harmful x-rays. Modern equipment is designed to keep the dose you receive as low as possible. If your doctor has asked for this test, they will have decided that the benefits from the procedure outweigh the risks from the very small dose of radiation that you receive.

What if I cannot attend my appointment?

If you have any queries about your appointment or cannot attend, then please telephone the booking office Monday to Friday 8.30am to 4.00pm on:
0161 204 2044/2404 (Salford Royal Hospital)
0161 624 0420 (Royal Oldham Hospital)

You can also email:
salford.radiology.booking@nca.nhs.uk (Salford Royal Hospital) or bookingandscheduling.outpatients@nca.nhs.uk (Royal Oldham Hospital). Please include name, date of birth, address and hospital number (if known) in any correspondence.

I need an ambulance. How do I arrange one?

If you need an ambulance there are contact details on your appointment letter.

Please contact us if you are arriving by ambulance so we can time your appointment with your ambulance arrival. If we are not aware that you are coming by ambulance you may miss your appointment and it may have to be rebooked.

If you need an interpreter

If you need an interpreter for your examination, please call the department so that we can try and arrange this.

Contact Details

We hope your questions have been answered by this leaflet.

If you require help or any other information regarding your appointment you can contact:

The Angiography Department, Salford Royal Hospital
Tel: 0161 206 2206/5091

Interventional Radiology, Royal Oldham Hospital.
Tel: 0161 656 1178