Semiology of Primary Bone Tumors of the Spine Including Diagnostic Algorithm

Abstract

In this chapter, we present an overview of the clinical and radiologic semiology of the benign and malignant bone tumors of the osseous spine, and we propose an imaging algorithm using an analytical approach to facilitate the diagnosis. Primary solitary osseous tumors of the spine are uncommon in comparison to metastases and myeloproliferative disorders such as multiple myeloma and lymphoma. Many solitary primary lesions have characteristic radiologic features that help to make the diagnosis with confidence. An analytic approach based on clinical information such as the age and the symptoms of the patient together with the radiologic semiology, the localization of the lesion within the spine segment and within the vertebra, and the multiplicity enables the radiologist to recognize tumors of the spine with characteristic features such as enostosis, osteoid osteoma, osteoblastoma, osteochondroma, chondrosarcoma, vertebral angioma, and aneurysmal bone cyst. The differential diagnosis may include other primary spinal tumors, vertebral metastases, and tumor-like conditions mimicking a spinal tumor, such as Paget disease, spondylitis, aseptic osteitis, the unilateral arch hypertrophy, or microcrystalline arthropathies. Conventional radiographs are the first step in the initial detection and characterization but are limited because of the complex anatomy of the spine and superposition. CT and MRI are the imaging techniques of choice for further characterization, staging, and guiding biopsy. The final diagnosis is based on the histopathological examination of the biopsy.