Primary and metastatic spine tumors

Spinal tumors constitute a challenging and formidable diagnosis or disease for the radiologist, surgeon, and oncologist. These tumors can be benign or malignant. The diagnosis can be achieved with radiographic studies, but not always. The accuracy of diagnosis relies heavily on the experience and knowledge of the radiologist. Past medical history, blood tests, bone marrow aspiration, or biopsy of the lesion may be necessary. Biopsies are often inconclusive, necessitating additional attempts. Treatment may consist of observation with sequential studies. Benign and malignant tumors can result in varying degrees of symptoms and deficit. Hence, the accuracy in diagnosis and management is paramount. In some malignant tumors, radiation and chemotherapy may be recommended before surgery, but in most following surgery. Prior to surgery, vascular tumors, such as metastatic renal cell carcinomas or aneurysmal bone cysts, may require preoperative embolization. Depending on the location of the tumor, surgery may be indicated thorough a posterior approach, other times anterior, and sometimes lateral, as in transthoracic or retroperitoneal. Surgery may consist of decompression. Other times, instrumentation is required to maintain stability. Such procedures are often lengthy, associated with significant blood loss, with risk of intraoperative as well as postoperative complications. A chapter such as this should help in diagnosing the nature of the spinal lesion and provide basic guidance in management.