Vertebral bone biopsy is an accurate, rapid, and cost-effective method to diagnose benign and malignant spine lesions. The major complications are uncommon. Nondiagnostic or insufficient specimens are encountered in less than ten per cent. The accuracy of the biopsy depends on the location and type of the lesion, needle system, and biopsy route. The major indications are focal lesions with non-specific medical imaging findings, to exclude metastasis in patients with known primary malignancy, lesion without response to treatment, no clinical improvement in children with diskitis after six weeks of therapy to exclude occult tumor and extreme pain due to vertebral collapse. If histology yields only peripheral blood elements in an obviously destructive mass, biopsy can be repeated, by directing at a slightly different area of the lesion. No more than three percutaneous biopsies of the same lesion should be performed.