DISC Biopsy

Biopsy

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Biopsy of intervertebral disc.

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DISC Biopsy - Comprehensive Medical Test Information Guide

Why is it done?
- Test Purpose: A DISC (Direct Intervertebral Space Catheter) biopsy is a minimally invasive diagnostic procedure used to obtain tissue samples directly from intervertebral discs in the spine to evaluate for infection, malignancy, or degenerative changes
- Primary Indications: Suspected spinal infection (discitis or osteomyelitis), evaluation of suspicious lesions seen on imaging, diagnosis of malignant involvement of disc space, assessment of inflammatory or degenerative disc disease, and confirmation of diagnostic findings when imaging results are ambiguous
- Timing and Circumstances: Performed when advanced imaging (MRI or CT) reveals abnormalities requiring definitive diagnosis, when clinical suspicion of infection persists despite negative non-invasive tests, in immunocompromised patients with fever of unknown origin affecting the spine, and when tissue diagnosis is necessary to guide specific treatment protocols
- Clinical Context: Often performed under fluoroscopic or CT guidance to ensure accurate needle placement; samples are sent for microbiological culture, histopathological examination, and molecular analysis
Normal Range
- Histopathology Normal Findings: Normal disc tissue shows fibrocartilage matrix with organized collagen fibers, viable chondrocytes distributed throughout, absence of inflammatory cells, no necrotic material, and intact endplate cartilage without degenerative changes
- Microbiology Normal Results: Negative bacterial culture (no growth), negative fungal culture (when appropriate), negative viral analysis, and absence of acid-fast bacilli (AFB) when TB suspected
- Interpretation of Normal Results: Indicates absence of active infection, no malignant infiltration, normal disc composition consistent with health or benign degenerative changes, and rules out serious pathology requiring urgent intervention
- Abnormal Results Categories: Positive cultures indicating bacterial (pyogenic), fungal, or mycobacterial infection; histologic evidence of malignancy; inflammatory infiltrate suggesting autoimmune or infectious etiology; and necrotic debris or granulomatous inflammation
Interpretation
- Positive Bacterial Culture: Confirms diagnosis of bacterial discitis or spondylodiscitis; common organisms include Staphylococcus aureus, Streptococcus species, Gram-negative rods, and anaerobes; results guide antibiotic selection with culture sensitivities
- Positive Fungal or Mycobacterial Culture: Indicates chronic spinal infection; Mycobacterium tuberculosis suggests TB spondylitis (Pott's disease); Candida or other fungi indicate immunocompromised state or specific exposure; requires prolonged antifungal or anti-tuberculous therapy
- Histologic Malignancy: Presence of atypical cells, increased mitotic figures, and loss of normal architecture indicates primary or metastatic cancer; specific diagnosis depends on cell type and immunohistochemical markers; requires oncology consultation
- Inflammatory Infiltrate: Increased white blood cells (lymphocytes, macrophages, neutrophils) may indicate infectious process, autoimmune condition, or inflammatory spondyloarthropathy; granulomas suggest tuberculosis or fungal infection
- Degenerative Changes: Disorganized collagen, chondrocyte apoptosis, calcification, and fibrosis are consistent with degenerative disc disease; absence of infection or malignancy reassures regarding prognosis
- Factors Affecting Interpretation: Prior antibiotic therapy may reduce culture sensitivity; timing of biopsy relative to symptom onset; immunocompromised status affecting organism growth; sampling from appropriate site (central vs peripheral disc); and contamination during collection
Associated Organs
- Primary Organ System: Skeletal system, specifically the intervertebral discs and adjacent vertebral endplates; also involves the nervous system (spinal cord and nerve roots) as they may be compressed by infection or malignancy
- Associated Conditions - Infectious: Bacterial discitis causing disc space inflammation and destruction; vertebral osteomyelitis with potential epidural abscess; tuberculosis (Pott's disease) with kyphotic deformity; fungal spondylitis in immunocompromised patients
- Associated Conditions - Neoplastic: Metastatic cancer to spine and discs, lymphoma involving vertebral bodies, multiple myeloma affecting disc space, and primary spinal tumors with disc involvement
- Associated Conditions - Degenerative and Inflammatory: Degenerative disc disease with structural failure, inflammatory spondyloarthropathies (ankylosing spondylitis), and autoimmune-mediated disc degeneration
- Potential Complications: Spinal cord compression from abscess formation causing paralysis, nerve root compression leading to radiculopathy or myelopathy, progressive kyphotic deformity from vertebral body collapse, and systemic sepsis from untreated infection
- Biopsy-Related Risks: Needle tract infection, vascular or neural injury, CSF leak if dura punctured, bleeding into epidural space, temporary increased pain at biopsy site, and rarely, meningitis if infection introduced
Follow-up Tests
- Additional Microbiological Testing: 16S rRNA gene sequencing for organism identification when culture growth is slow or organism identification is unclear; antimicrobial susceptibility testing to guide targeted antibiotic therapy; fungal or mycobacterial-specific media if special organisms suspected
- Histopathological Studies: Immunohistochemistry for malignancy characterization and primary vs metastatic determination; special stains (Gram, Ziehl-Neelsen, GMS) for organisms if culture negative; flow cytometry if lymphoma suspected
- Imaging Follow-up: Follow-up MRI or CT at 4-6 weeks to assess treatment response, evaluate for epidural abscess or spinal cord compression, and monitor for complications; repeat imaging if clinical deterioration occurs
- Laboratory Monitoring for Infection: Serial blood cultures if bacteremia suspected, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) to monitor inflammatory response and treatment efficacy, procalcitonin levels for sepsis assessment
- Repeat Biopsy Considerations: Indicated if initial culture negative but high clinical suspicion of infection persists, inadequate specimen obtained on first attempt, or disease progression despite negative initial results; typically performed at different spinal level
- Specialty Consultation: Infectious disease consultation for positive cultures requiring prolonged antimicrobial therapy; oncology referral if malignancy confirmed; neurosurgery evaluation if cord compression or instability develops; rheumatology if autoimmune disease suspected
- Monitoring Frequency: Clinical assessment every 2-4 weeks during acute infection treatment; imaging evaluation every 4-6 weeks for first 3 months; laboratory markers checked every 2-4 weeks; long-term imaging at 3-6 months to document healing and exclude sequelae
Fasting Required?
- Fasting Status: YES - Fasting is typically required if the procedure will be performed under general anesthesia or moderate sedation; fasting duration is generally 6-8 hours before the procedure (similar to surgical requirements)
- Fasting Instructions: NPO (nothing by mouth) from midnight if procedure scheduled in morning, or 6 hours prior if afternoon procedure; may have small sips of water until 2 hours before procedure if permitted by anesthesiologist; follow specific instructions provided by your facility
- Medications to Avoid: Discontinue anticoagulants (warfarin, apixaban, rivaroxaban) 3-5 days before procedure or as directed by physician; hold antiplatelet agents (aspirin, clopidogrel) 5-7 days before unless cardiac stent in place; continue essential cardiac medications unless otherwise instructed
- Medication Management: Diabetic medications should be held morning of procedure; blood pressure medications may be taken with minimal water; notify physician of all medications including supplements; some pain medications may need temporary adjustment
- Additional Patient Preparation: Arrange transportation as you cannot drive after sedation; wear loose, comfortable clothing that allows spine access; remove all jewelry, piercings, and metal objects; inform staff of any allergies, especially contrast or local anesthetics
- Pre-Procedure Laboratory: Recent coagulation studies (PT/INR, PTT) required if on anticoagulants; complete blood count to assess bleeding risk; renal function tests (creatinine, BUN) if contrast anticipated; baseline culture if infection evaluation primary indication
- Imaging Requirements: Recent spine imaging (MRI or CT) must be available in procedure suite for guidance; bring all imaging CD copies if procedure performed at different facility; ensure adequate images of target disc level and surrounding anatomy

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