Objective Determine computed tomography-guided percutaneous spine biopsy specimen adequacy, pathology-imaging concordance, and negative predictive value with battery-powered drill vs manual approach. Materials and Methods One-hundred-fourteen consecutive computed tomography-guided percutaneous spine biopsies in 109 patients (age: 61.1 ± 15.4 years; range: 17-90 years; males: 55, 50.5%; females: 54, 49.5%) performed at a single institution from September 2013 through January 2017 were retrospectively reviewed. Specimen adequacy was recorded. Imaging-pathology concordance was assessed. Chi-square tests compared specimen adequacy and imaging-pathology concordance obtained with a battery-powered drill vs manual approach. Negative predictive values were calculated. Results Battery-powered drill yielded slightly better, but not statistically significant, specimen adequacy (96% vs 90% overall, P = 0.270; 96% vs 89% for suspected neoplasm, P = 0.278; 95% vs 90% for suspected infection, P = 0.514), pathology-imaging concordance (82% vs 74% overall, P = 0.301; 92% vs 77% for suspected neoplasm, P = 0.107; 71% vs 65% for suspected infection, P = 0.602), and negative predictive value (65% vs 41% overall; 75% vs 33% for suspected neoplasm; 58% vs 33% for suspected infection). Four battery-powered drill procedures were technically unsuccessful. Conclusions Use of a battery-powered drill appears to yield similar to slightly better spine biopsy specimens than a manual approach, but also appears to carry a greater risk of technical failure. The battery-powered drill may be particularly helpful for procedures with complex approaches, but trajectory planning remains of paramount importance.