The compartment location of the lesion in the spinal column (extradural, intradural–extramedullary, or intramedullary) must be identified. Although most lesions have particular identifying characteristics, it is still imperative that, to arrive efficiently and effectively at the correct diagnosis of a spine tumor, the following steps are followed rigorously when reviewing imaging studies 4, 6:ġ. 9Įpidemiologic data suggest that most patients with suspected spine tumors are eventually shown to have meta-static (rather than primary) disease in the vertebral body (rather than in other locations) and that metastatic and primary lesions (benign and malignant) can occur within any segment and compartment of the spine and in men or women of almost any age. In addition, although all segments of the spine can be affected, such lesions occur most often in the thoracic spine (approximately 70%), followed by the lumbar spine (20%) and then the cervical spine and sacrum (10%). 1, 3 Metastases can occur in any compartment of the spinal column, but the vertebral body is the site most commonly affected (approximately 85%), 9 followed by the paravertebral region, epidural space, and intradural compartment. 8 Prostate, lung, and breast cancer account for most of such lesions. Up to 40% of patients with cancer develop visceral or osseous metastases, and the spinal column is the most common site of osseous metastases. As systemic therapies for metastatic disease have improved and the life expectancy of such patients has increased, the incidence of metastatic spread to the spine has also increased. 7 Such lesions occur primarily in the extradural compartment, especially in the osseous structures. Although a large number of primary lesions may occur in the spinal cord, nerve roots, dura, and osseous spine, most lesions within the spine are metastatic tumors. Spine tumors also are classified by type of origin as primary or metastatic. Although orthopaedic surgeons most commonly manage tumors of the extradural compartment, they must have an understanding of the other two compartments to provide comprehensive patient care and to communicate effectively with neurosurgical colleagues. The extradural compartment consists of all structures outside the dura, including the osseous structures, the paravertebral region (including the paraspinal musculature), and the epidural space. Spine tumors are traditionally classified by anatomic location into three compartments: 1– 6
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