The value of percutaneous CT-guided biopsies of the axial skeleton for establishing a diagnosis is determined from a series of 75 punctures in 74 patients in retrospect. Indications showed benign conditions to prevail over malignant lesions by a ratio of 1.6:1. Biopsy routes turned out to be strongly determined by regional anatomy allowing for a standardised procedure in each area. 64 out of 75 histological diagnoses were confirmed by open surgery (n = 17) or follow-up (n = 58) accounting for an accuracy of 85.3%. In 7 cases no definite diagnosis could be made from the sample and in 4 cases the diagnosis proved false although tissue cores could be obtained in each case. No serious or irreversible complications occurred. CT-guided punctures of the axial skeleton are considered a safe and highly accurate procedure to establish a definite diagnosis unless there is a primary indication for surgery or the need for decompression.