Spine Flashcards
Most common benign spine tumors?
ABC, eosinophilic granuloma, giant cell tumor, hemangioma, neurofibroma, osteoid osteoma, osteoblastoma, osteochondroma
Primary malignant spine tumors?
Less than 5% of all spine tumors: chondrosarcoma, chordoma, Ewing sarcoma, multiple myeloma, osteosarcoma
Most common spine tumor?
Metastatic disease: breast, lung, thyroid, renal and prostate; usually in vertebra, spare disc.
Most common site for skeletal metastasis?
Spine
Benign spin tumors?
Tend to occur in children and involve the posterior elements.
Malignant spine tumors?
Tend to occur in adults and involve the vertebral bodies.
Most common region for spinal mets?
Thoracic spine
Most common presenting complaint for spine tumor?
Pain (night pain very common)
Acute onset or worsening pain in spinal tumors?
Suggests fracture.
MRI for suspicion of spine tumor?
Order with IV gadolinium because more vascular regions will be highlighted.
Specific labs for multiple myeloma?
SPEP and UPEP
Definitive diagnosis of spinal tumor?
Biopsy (fine needle, core, or excisional). Consider CT or MRI guided. Tattoo the needle tract for excision later.
Most widely accepted staging system for spinal tumors?
Weinstein, Boriani, and Biagini (WBB). Divides axial plane of vertebral body into 12 zones like a clock face. Also divides tissues from periphery inward into 5 zones (extraosseous tissues, intraosseous superficial, intraosseous deep, extraosseous epidural, extraosseous intradural).
ABC lesion in spine?
Second decade of life; 20% w/i spine, mostly posterior elements; expansile lytic lesion with rim of reactive bone, fluid filled levels. Tx = arterial embolization, curettage, or en bloc resection (needs preop embolization).
Eosinophilic granuloma in spine?
AKA Langerhans cell histiocytosis; first and second decade of life; affects vertebral body; vertebra plana commonly seen; histologic analysis critical to distinguish; intralesional corticosteroid injection once known; most resolve spontaneously.
Giant cell tumor of spine?
Can be aggressive; typically occur in third decade of life; typically vertebral body; sacrum most commonly affected; expansile lytic lesion with soft-tissue involvement; tx = en bloc excision if possible, otherwise intralesional extracapsular excision; adjuvant radiation may increase success but 5-15% chance of high-grade sarcoma; recurrence rates lowest at tertiary tumor referral center (18% vs 83%).
Hemangioma of spine?
Usually asymptomatic; large lesions may cause fracture, instability, or compression of neural elements; large lesion with vertical striations; speckled appearance on CT; MRI = increased signal intensity on T1 and T2; tx = percutaneous cement augmentation if needed and/or decompression/stabilization.
Neurofibroma of spine?
Associated with neurofibromatosis; typically occur within dura; if in neuroforamen then classic dumbbell-shape; x-rays show penciling of rib heads, enlarged neuroforamina and vertebral scalloping; tx of symptomatic lesions with excision; if results in scoliosis then fuse.
Osteoid osteoma of spine?
Typically in second decade of life; pain unrelated to activity, increased at night; pain resolves with NSAIDs; can cause painful scoliosis; CT = nidus of bone with sclerotic rim; bone scan = hot lesion; most common in posterior elements; resolution with NSAIDs can take 36 months; can be treated with radiofrequency ablation if far enough away from neurologic structures; excise lesions close to neurologic structures (associated scoliosis will resolve if excised w/i 15 months of onset).
Osteoblastoma of spine?
40% occur in spine; most commonly in posterior elements of cervical and lumbar spine; similar to osteoid osteoma w/o relief from NSAIDs; lesion usually larger than osteoid osteoma (>2cm); expansile lytic lesion that may expand into soft tissues; tx with curettage or en bloc excision.
Osteochondroma of spine?
Commonly affects posterior elements of cervical and upper thoracic spine; x-ray shows pedunculated mass; CT/MRI shows cartilage cap; asymptomatic lesions = no tx; 1% risk of malignant transformation into chondrosarcoma; 25% risk if multiple hereditary exostosis.
Chondrosarcoma of spine?
Typically present in 5th decade; if in posterior elements, may be malignant transformation of osteochondroma; if in vertebral body, likely primary lesion; lytic lesion with poor margins and stippled calcifications; CT/MRI shows cartilagenous cap; tx = en bloc excision; proton/photon rads tx if not clean margins.
Chordoma of spine?
Rare but most common primary malignant spine tumor in adults; typically 5th/6th decade; most common in sacrum then upper cervical spine; evolve from remnants of notochord with midline location; lytic or mixed lytic lesion; CT/MRI shows large soft tissue expansion; slow growing/insidious onset; sacral mass may have palpable lesion on rectal exam; tx = en bloc rsxn but high risk of bowel/bladder/sexual dsfxn (try to save bilat S2 or unilateral S2/3/4 nerve roots); survival rates 5-10 yrs; chemo targeted against molecular tyrosine kinase and angiogenesis pathways.
Ewing sarcoma of spine?
2nd decade of life; pain/swelling/constitutional symptoms; most common in sacrum; neurologic symptoms common; moth-eaten appearance with poor margins; MRI shows soft-tissue extension; tx = neoadjuvent chemo, radiation, en bloc excision.
Multiple myeloma of spine?
Most common primary malignant bone lesion; malignant transformation of plasma cells; 6th/7th decades; occasional neurologic deficits; punched out lytic lesions; lesions cold on bone scan; SPEP/UPEP +; tx = chemo/rads, bracing, bisphosphonates; combined tx with thalidomide and dexamethasone; vertebroplasty/kyphoplasty; may be solitary plasmacytoma can progress to MM but are highly radiosensitive; surgery for instability/neurologic signs; survival of plasmcytoma 60 months vs MM 28 months.
Osteosarcoma of spine?
2nd decade of life; rare in spine; usually vertebral body; lytic, blastic or mixed; tx = neoadjuvant chemo and en bloc rsxn.
Scoring system for spinal mets?
Tokuhashi; total of 15 points; 8 or less = palliative care; 9 to 11 = 6 months survival w/ palliative surgery; 12 or more = 1yr or greater survival and excisional surgery.
Radiosensitivity of spinal mets?
High = myeloma and lymphoma; moderate = breast and prostate; resistant = lung, colon, renal cell, sarcoma, melanoma.
