Fig. 4

Illustration showing steps of the biopsy. A Navigated PAK (Pedicle access Kit, Medtronic) needle used to get projection and then skin stab incision is put. B PAK needle is introduced and pushed to land at pediculo-facet junction. C Its trocar is introduced further to reach beyond the posterior border of body under virtual images on navigation screen. D Trocar is withdrawn. E Guide wire is introduced positioned into the vertebral body. F The outer sheath of PAK is removed. G Dilator is put on guidewire. H Serrated Biopsy canula is put on the dilator & guide wire to reach pediculo-facet junction I Then guide pin & dilator are removed. J The third party tracker guided trocar is introduced and is further pushed to reach in vertebral body safely at or beyond the pedicle to body junction under virtual images of navigation. K The trocar is removed. L The pre-calculated length of biopsy forceps is introduced and is used as per the location of biopsy target lesion with a stopper. Single shoot 2D is taken beforehand to confirm the position and safety