Clinical and plain x-ray findings of spinal metastases: a retrospective study of pathologically-confirmed cases

Abstract

Background: Malignancy of breast, prostate, and lung contribute to metastatic bone disease, and the metastases are mostly located in the spine. Spinal metastases may involve the spinal cord, leptomeninges, epidural space and also the bone itself. Therefore, proper imaging is needed in early detection and diagnosis of spinal metastasis. This study aimed to perform the clinical and plain x-ray findings in patients with spinal metastasis.  Method: A retrospective study was conducted on 28 spine pathological fracture patients with neurologic deficits who underwent surgical intervention in Sanglah General Hospital during a year. We evaluated the present symptoms, neurological status (Frankel score), pathological reports by plain x-ray findings, metastases cell type by histological assessment, and extension of mass expansion on MRI. A total of 20 cases that met the inclusion criteria were evaluated.Result: Most patients suffer from pathologic fracture on thoracic spine level, followed by lumbosacral level and none on cervical spine level. The compressive fracture was a major finding on plain x-ray. The extradural lesions account for most of the MRI findings, followed by intradural/extramedullary and intramedullary lesion. Primary tumours that lead to bone metastases in this serial-cases are prostate, breast, cervix, kidney and lung cancer, respectively.Conclusion: Thoracic spine is the most common spinal metastases manifestation. Conventional plain x-ray is the most initial modality to evaluate systemic neoplasia patients with spinal pain, although it is not a sensitive indicator to identify the presence and extent of metastatic involvement.