This 62-years old man had backache and MRI showed classic infectious spondylitis. The CT scan shows the lesion well at L4/5, with no significant soft tissue on the MRI or CT scan.

Rule: Every infectious spondylitis has to be biopsied. Since the lesions were in the bone, a transpedicular into the vertebral body lesion was simple and straightforward. Using mild intravenous sedation with an 18G coaxial biopsy gun lightly tapped through the pedicle, the biopsy showed PCR MTB +ve without rifampicin resistance.