Fine needle aspiration cytology (FNAC) of radiologically detected vertebral and paravertebral lesions is now used extensively for diagnosis and further management of patients. In this study, we report our experience with image guided FNAC diagnosis of vertebral and para-vertebral lesions in a total of 150 cases. Out of a total of 150 patients, 34 (22.7%) cases were positive for malignancy, 61 (40.7%) cases were benign non neoplastic lesions, 23 (15.3%) had inadequate/ unsatisfactory material for diagnosis, 31 (20.7%) had normal cellular elements of bone marrow and 1 (0.6%) case was diagnosed as a benign nerve sheath tumour. Radiologically guided FNAC is a simple, cost effective procedure in vertebral and paravertebral lesions.