An overview of the tumors affecting the spine-inside to out

Abstract

Spine tumors may arise within or surrounding the spinal cord and/or vertebral column. Spinal tumors can be benign or malignant. Based on their epicenter, they may be classified as intradural-intramedullary, intradural-extramedullary, or extradural. Of these, extradural lesions are the most common, and are typically metastatic. Primary bone tumors of the spinal column comprise 5% of all primary skeletal tumors. The majority of primary spinal column tumors are benign, with malignant tumors comprising only 20%. Overall, spine metastases are the most common malignant spine tumor, and these usually arise from primaries such as lung, breast, and prostate cancers. The advent of improved systemic therapies leading to improved survival and the frequent use of imaging has positioned metastatic spine disease as the new epidemic in oncology. For spine tumors, establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation. In this review, we will provide an overview of the epidemiology, radiological and histopathological features, and the natural history of key primary (benign and malignant) spinal cord and column tumors and metastatic spine tumors. Treatment principles for primary spinal cord or column tumors are aimed toward curative resection, whereas palliative resection forms the treatment principle for most metastatic tumors.

Keywords: spine metastases; spine neoplasm; spine tumors.

Figure 1.

Diagram showing the various anatomical locations of spine tumor.

Figure 2.

A, A 7-year-old girl with neck pain. Clival chordoma on MRI axial T1 postcontrast sequence. The arrow points to a heterogeneous contrast-enhancing mass with a “honeycomb” appearance in the right craniocervical junction. B, Histopathology slide of the same patient who had undergone surgical debulking. Clusters of lobular-appearing physaliphorous tumor cells (1) are seen in a prominent myxoid stroma (2). The tumor cells display round to oval hyperchromatic nuclei with mild atypia and abundant vacuolated cytoplasm. The tumor tissues are surrounded by a fibrous pseudocapsule (3).

Figure 3.

Algorithm for management of metastatic spine disease. Adapted from Kumar et al. CTx, chemotherapy; MIS: minimally invasive surgery; MSD: metastatic spine disease; Neuro: neurological; RTx: radiotherapy; SINS: Spinal Instability Neoplastic Score.