In recent years, medical imaging technology has developed rapidly, and the vast majority of spinal puncture biopsies of the tract are done under CT guidance many diseases can be diagnosed almost solely with the help of imaging, but into, and mostly done by radiology imaging physicians. Because of the hospital’s in the diagnosis and differential diagnosis of bone tumors or related diseases, pathology many objective reasons, our hospital since January 2006, began to try still considered the gold standard. In the guidelines for the treatment of bone tumors, “puncture (or incisional) biopsy” by a bone tumor specialist in the operating room under X-ray surveillance is defined as a necessary step before treatment. As of June 2010, preoperative puncture biopsy of limb bone tumors has been widely accepted and performed in 145 cases. Relatively speaking, the low rate of puncture biopsy of spinal tumors or lesions may have the following reasons: (1) the anatomy of the spine is special, and it is difficult to perform puncture on it compared with the limb information and the method body; (2) due to the difference in the development and division of labor within different hospitals, some patients with spinal tumors are admitted I. General information into the spinal surgery department instead of the bone oncology department, and physicians from different departments to the swelling since January 2006 to The awareness of different departments about the total admission and tumor from January 2006 to June 2010 differs to some extent. I. Data and Methods There were 95 male cases and 50 female cases, aged 21-75 years old, average 55 years old. Tumor involvement: 87 cases in thoracic spine and 58 cases in lumbar spine, including 94 cases in single vertebrae and 51 cases in multiple vertebrae. The main symptoms of the patients were local pain and Frankel classification of nerve function: grade A in 4 cases; grade B in 12 cases; grade C in 47 cases; grade D in 59 cases; grade E in 23 cases. All patients underwent routine spine tumor-related examinations after admission, including blood chemistry, chest CT, spine X-ray, CT, MRI, and ECT. Puncture biopsy was routinely performed to clarify the pathological diagnosis. The patient is positioned prone, and the C or G-arm fluoroscope is used to locate the lesioned vertebral body, and the vertebral arch is selected for puncture according to the location of the lesion (bilaterally if necessary), and the lesioned vertebral body is used as the center of the field of view during fluoroscopic positioning. The needle is inserted 1 to 2 cm (depending on the patient’s body type) outward from the upper edge of the projection point of the vertebral pedicle, under local infiltration anesthesia with 1% lidocaine (with intravenous analgesics under cardiac monitoring if necessary), with reference to the percutaneous pedicle screw placement method [1], the sagittal and coronal angles are adjusted under X-ray surveillance, the bone penetrating needle is drilled, and when the tip of the penetrating needle approaches the lesion, the needle core is withdrawn and the outer The outer sleeve was rotated 360° in situ, a 20 ml syringe was attached to the end of the sleeve, and the outer sleeve was slowly withdrawn under negative pressure with continuous suction, and the biopsy specimen was finally ejected from the sleeve using the needle core and fixed for examination. Results I. Operation results In this group of 145 cases, 116 cases of unilateral single puncture were successful (the standard was to remove a solid specimen of length >0.5 cm), 14 cases of unilateral second puncture were successful, 11 cases of multiple punctures on both sides were successful, 1 patient requested to give up in the middle, and 3 cases of puncture failure. The puncture time was 1045 min, with an average of 20 min. After the puncture specimens were sent for examination, a clear pathological diagnosis was obtained in 130 cases, with a positive rate of 89.7%. Among them, 82 cases were metastases, 14 cases were myeloma, 11 cases were primary tumors of the spine, 8 cases were lymphoma, 8 cases were infections, 6 cases were osteoporosis, and 1 case was parasitic disease. Complications During the puncture process, three patients experienced discomfort such as panic and chest tightness, which were not relieved after brief treatment by anesthesiologists and improved after abandoning the operation. four patients experienced symptoms of nerve irritation or aggravation of original nerve symptoms during and later after the puncture process, which were relieved or restored to pre-puncture after treatment such as dehydration. Postoperatively, hematoma appeared at the puncture port in 3 cases, which resolved on its own after 1 week. In all cases, the punctured eye healed within 2 weeks. IV. Follow-up results The 130 patients who obtained pathological diagnosis by puncture were followed up for 1-3 months, among which 21 cases gave up treatment or lost follow-up, 23 cases received medical treatment after puncture, 86 cases received surgical treatment, and 73 cases had pathological match between postoperative pathology and biopsy pathology, and the accuracy rate of biopsy was 84.9% (73/86). Discussion I. Significance of puncture biopsy of spinal vertebral body lesions The significance of puncture biopsy of spinal vertebral body lesions is mainly twofold, one is to clarify the diagnosis as soon as possible. In addition to primary lesions or tumors, there are also secondary or metastatic tumors. Due to the special anatomical characteristics of the spine, its lesions are not easily detected or diagnosed in the early stage, and more serious neurological symptoms will appear in the later stage, so early diagnosis and treatment are especially important. Puncture biopsy for suspicious malignant tumor lesions is in accordance with the principles or procedures of bone tumor treatment. Routine puncture biopsy for suspected malignant bone tumors of the extremities has been written into the bone tumor treatment routine, and the literature has confirmed that preoperative neoadjuvant chemotherapy based on puncture biopsy pathology significantly improves the outcome of malignant bone tumors. Based on similar histological characteristics and other factors, preoperative chemotherapy may be beneficial for some spinal malignancies (primary or metastatic) to improve the safety of intraoperative boundaries and prognosis; not only that, for some tumors involving the spine (lymphoma, myeloma), it may be possible to achieve cure with radiation and chemotherapy alone based on puncture results, avoiding unnecessary surgical treatment (except for fractures or nerve compression). In addition, a puncture biopsy is also an effective way of treating lymphoma. In addition, puncture biopsy is a key tool in the differential diagnosis of difficult spinal lesions. Second, the choice of puncture biopsy method Currently, most thoracolumbar vertebral body puncture biopsies are performed using a posterior transpedicular approach, which has the advantage of being anatomically safer, and secondly, by changing the angle, most areas of the vertebral body can be reached via the pedicle. The disadvantages are: there are still blind areas on the vertebral body that cannot be reached via the pedicle, and secondly, there is a risk of tumor contamination of the needle tract during any puncture operation. The methods of puncture biopsy are similar, but the differences are mainly in the surveillance system and the puncture needle. Because of the anatomic nature of the spine, puncture biopsies must be guided by a surveillance system. The choice of monitoring system may be influenced by a number of factors, including the operator’s own professional background. Earlier, most of these puncture biopsies were performed by imaging physicians under CT surveillance; however, as orthopedic surgeons have become more proficient in pedicle techniques (internal fixation, vertebroplasty, etc.), it is not difficult to perform puncture biopsies under X-ray (C-arm, G-arm) surveillance. The present authors mainly used X-ray fluoroscopy, and compared with the more commonly used surveillance under CT in the literature, concluded that the former has the following characteristics: (1) the imaging effect may not be as precise and intuitive as the latter, but the surgeon’s operational experience can compensate; (2) the operational speed and convenience of X-ray fluoroscopy is better than that of CT scan; (3) in comparison, the former has less radiation than the latter, both for the operator and the patient; (4) X-ray fluoroscopy can be done in the operating room, which is superior to the CT imaging room in terms of adjunctive analgesia, vital sign monitoring, and sterile conditions. the incidence of complications of X-ray versus CT-guided percutaneous spinal puncture biopsy was 5.3% and 3.3%, respectively, which was not statistically significant. The diameter of the biopsy needle used for puncture in our group was 3.0 mm, and the diameter of the puncture needle reported in the literature ranged from 1.5 to 3.0 mm. In general, the larger the diameter of the puncture needle, the higher the rate of confirmation of its puncture biopsy; the rate of confirmation in our group was 89.7%, and the rate of confirmation reported in the literature ranged from 67% to 100% [2-3]. Of course, the increased diameter of the puncture needle also increases the risk of puncture complications. Combining our cases and literature, the complications include: lung injury, nerve injury, bleeding, and infection [4]. In addition, flexible indications for puncture biopsy can help to reduce complications, especially for patients whose lesions involve the posterior edge of the vertebral body or who have developed obvious symptoms of nerve compression, they should carefully consider whether to perform puncture biopsy or direct surgical decompression, because puncture may lead to bleeding within the lesion and aggravate nerve compression, etc. The technology of vertebral body puncture biopsy needs to be further improved, such as the application of computer navigation technology and rapid freezing of puncture biopsy tissues may be beneficial in improving the rate of puncture diagnosis while reducing the incidence of complications