◊Most common vertebral tumor!

Prevalence: 5–10% of cancer patients

Age: usually >50 years of age

Source:

1. Metastatic tumor: lung, breast, prostate (15–20%) >kidney, lymphoma, malignant melanoma
2. Primary tumor: multiple myeloma

Spread:

1. hematogenous spread to vertebral body (bones with greatest vascularity) + epidural space
2. contiguous spread from paraspinal region: lymphoma, sarcoma, lung carcinoma

• back pain; motor deficits; sensory abnormality
• autonomic dysfunction (bladder, bowel)

Location: thoracic >lumbosacral >cervical spine

Clues:

• multiple lesions of variable size
• pedicles often destroyed
• vertebral compression fracture
• associated epidural tumor
• cortical disruption (= osteolysis)

Radiograph:

• osteolytic >>osteoblastic >mixed metastases

MR (93% sensitive, 97% specific, 97% accurate):

• patchy multifocal relatively well-defined lesions
• diminished signal on T1WI on background of high-signal appearance of marrow fat
• increased signal on T2WI (except for blastic metastases with diminished T1 + T2 signals)
• contrast enhancement on T1WI (majority)
• pathologic compression fracture:
  • fracture only after all vertebral body fat replaced
  • hyperintense on diffusion-weighted images (DDx: hypointense benign osteoporotic fracture)
• Whole-spine MRI to search for multifocal involvement!

Risk: malignant spinal cord compression (5–10%)

• Metastatic extension into spinal canal can result in neurologic symptoms and paralysis.

DDx:

1. Infection (centered around disk space)
2. Primary vertebral tumor (rare in older patients, almost always benign in patients <21 years of age)