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The authors report the results of a prospective study about CT-guided percutaneous transpedicular vertebral biopsy in 23 patients, 11 male and 12 female, with a mean age of 45 years (range, 17-90 years). Eleven biopsies were performed at a thoracic level, 12 at a lumbar or sacral (one) level. A diagnosis was obtained in 21 out of 23 patients (91.3%); in the remaining two cases an open biopsy was necessary, which led to the diagnosis of aneurysmal bone cyst. CT-guided percutaneous transpedicular biopsy is an effective and safe method. The transpedicular approach is especially useful for thoracic lesions, because it avoids pulmonary complications such as pneumothorax, without increasing the rate of neurologic problems. This method is not suitable for the diagnosis of aneurysmal bone cysts.