Utility and challenges in intraoperative consultation of spinal lesions by crush smear cytology

Background: Various methods are used for intraoperative consultation of spinal lesions. Crush smear cytology is one such method that is accurate, rapid, and allows preservation of tissue for paraffin-embedded sections. Aims: To study the cytomorphology of various neoplastic and nonneoplastic lesions involving and compressing the spinal cord. To evaluate accuracy and discuss diagnostic pitfalls of crush smear cytology. Materials and Methods: Over a period of 5 years (January 2008 to October 2012), a total of 57 spinal lesions were referred for intraoperative cytology. In four cases, material was inadequate for evaluation, so we analyzed 53 cases. Results: Majority of lesions were neoplastic accounting for 86.79% whereas nonneoplastic lesions constituted 13.20%. Most of the tumors were low grade (82.92%). Overall accuracy rate was 90.56% with accuracy of 91.30% and 85.71% for neoplastic and inflammatory lesions, respectively. Conclusion: Crush smear technique is a simple, reliable, easy, and rapid method for diagnosing neoplastic and inflammatory lesions involving and compressing the spinal cord. It gives an immediate idea of prognosis so that surgeon can modify the operative procedure, if necessary.