CT-guided vertebral biopsy is a simple, non dangerous, and usually an effective method for the actiological diagnosis and the treatment of vertebral lesions. The authors detail the biopsy technique, the needles and the route used according to the anatomical distribution and the osteosclerotic or osteolytic aspect of the vertebral lesion. In 60% of ordinary infectious spondylodiscitis the biopsy is positive. Early diagnosis of tuberculous spondylodiscitis is usually possible only to anatomopathological examination on osteodiscal samples. In tumoral disease the association of biopsy and cytological specimens provides the best results, specially in osteolytic vertebral lesions.