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INTRODUCTION

Neoplastic diseases in the spinal column and spinal cord can have a dramatic impact on an individual as well as on their family members and friends. The tumor or its management may directly or indirectly cause neurologic impairments that affect the physical, social, vocational, and emotional capabilities of the individual. The available treatment options for both primary and metastatic spine tumors have improved and brought with them improved patient survival. Knowledge of recent developments in diagnosis and therapies is therefore critical for the management of these patients.1

EPIDEMIOLOGY

Spinal tumors are classically grouped into three categories: extradural tumors, intradural extramedullary tumors, and intradural intramedullary tumors (Fig. 17–1). These tumors maybe primary or secondary to metastatic disease. Primary tumors account for a relatively small percentage of all spinal tumors and generally occupy the intradural spaces; in contrast, spinal tumors secondary to metastatic disease tend to be extradural.

Figure 17–1

Axial diagram demonstrating different locations of spinal neoplasms.

Extradural tumors refer to lesions outside of the dura mater, in the vertebral bodies and neural arches. Primary extradural tumors arise from osteoblasts, chondrocytes, fibroblasts, and hematopoietic cells. These tumors are more commonly malignant than benign. Primary malignant extradural lesions include lymphoma, osteosarcoma, Ewing's sarcoma, chondrosarcoma, chordoma, sacrococcygeal teratoma, malignant fibrous histiocytoma, solitary plasmacytoma, and fibrosarcoma. Benign lesions include vertebral hemangioma, which is most common, giant cell tumors, osteochondroma, osteoid osteoma, and osteoblastoma.2

Metastatic disease is far more common in the extradural space. Over 18,000 new cases are diagnosed each year, with up to 70% prevalence in patients with cancer. Lung, breast, and prostate cancers are the most common primary solid tumors that metastasize to the spine. Renal cell carcinoma, thyroid cancer, and colon cancer are also relatively common. Among hematologic tumors, non-Hodgkin's lymphoma is the most common.2,3

Depending on the underlying malignancy, 2% to 5% of patients will develop clinical signs and symptoms of epidural spinal cord compression (ESCC) during the course of their disease. In most cases (80%), ESCC results in patients with known history of malignancy. In 20% of patients, it is the first manifestation of underlying malignancy. This is particularly common in patients with lung cancer and hematologic malignancies. Patients with myeloma and prostate cancer have the highest risk of developing ESCC (7.9% and 7.2%, respectively). In the pediatric population, sarcoma and neuroblastoma are the most common malignancies resulting in ESCC.3 Symptomatic lesions are most often diagnosed in the thoracic region, presenting with incomplete paraplegia, though cadaveric studies have shown the most common site of tumor burden is in the lumbar spine.4

Primary intradural extramedullary tumors are located within the dura mater but outside the spinal cord parenchyma. They arise from peripheral nerves, nerve sheaths, and sympathetic ...

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