Thoracolumbar vertebral lesions, divided into primary vertebral lesions and metastatic vertebral lesions, regardless of the type of lesion, a clear diagnosis is the basis for effective treatment. In addition to the patient’s symptoms and signs and imaging, the main and most reliable diagnostic technique for thoracolumbar spine diseases is biopsy. C-arm guided puncture biopsy can help guide clinical treatment for malignant metastatic bone tumors and cases where the primary lesion has not been identified, avoiding unnecessary surgical examinations that cause pain to patients and providing a reliable basis for their clinical development of appropriate treatment plans. Puncture biopsy has been clinically proven to be a safe, effective and economical method of examination. In 1934 and 1948, Ball and Valls reported posterior-lateral approach vertebral body puncture biopsy; in 1956, Craig described the use of posterior-lateral puncture vertebral body biopsy, and “C-arm” guided vertebral body puncture biopsy is a simple, less invasive diagnostic technique for patients with clinical data, radiographs, CT imaging, etc. C-arm” guided vertebral body aspiration biopsy is a simple, less invasive diagnostic technique that provides a reliable histocytological basis for qualitative diagnosis when the diagnosis of atypical spinal vertebral lesions is not clear from clinical data, X-rays, CT imaging, etc. The technique is characterized by accurate positioning and a high success rate of puncture, ensuring that tissue cells at the core of the lesion are obtained. Complications: There are homotopic nerve roots at the inner lower edge of the arch, superior nerve roots at the outer upper edge, the spinal cord and dural sac inside, and large vessels such as the aorta in front of the vertebral body; there are common iliac arteries and veins in front of the L3 and L4 arch; large vessels in the sacral segment pass on both sides of the sacral wing, and the median sacral artery often travels in the anterior middle of the sacrum and its position is uncertain. If the puncture needle breaks through the vertebral arch or penetrates the anterior edge of the vertebral body, it may cause injury to blood vessels, nerves and spinal cord. When puncture is difficult, the needle can also be used to enter the vertebral body via the extra-vertebral arch and the supra-vertebral arch. The key to vertebral body puncture biopsy is to take material, puncture location is not allowed, take too little material, take material fragmentation, more hematoma can cause pathological diagnostic errors, so the needle used to take material should be thick enough and long enough, the general diameter of 2 ~ 3.5 mm puncture needle is appropriate, the amount of material taken during puncture should be sufficient, generally take the diameter of 3.5 mm, the length of 10 ~ 20 mm tissue column, to ensure the need for pathological examination.