spinal metastases

Spinal metastases is a vague term which can be variably taken to refer to metastatic disease to any of the following:

Each of these are discussed separately. Below are some general remarks on metastatic disease to the spine, theca and cord.

Epidemiology

Approximately 90% of all spinal (cord + vertebral) neoplasms are considered metastatic in origin.

Clinical presentation

Presentation can be highly variable. Sudden onset development of the Brown-Sequard syndrome in patients with known metastatic cancer has been described as a presenting feature .

Pathology

Spread of malignant cells to the region is variable and includes:

  • haematogenic: arterial or venous
  • direct invasion: typically of paraspinal, retroperitoneal of pulmonary malignancies
  • lymphatic: along the root sleeves
  • subarachnoid: intracanalicular seeding of primary and secondary CNS neoplasms

As the vast majority of metastases to the region are to bone, this is reflected in the primaries which are encountered. Having said that breast cancer, lung cancer and melanoma are also relatively common sources of intradural disease.

Primaries include:

Differential diagnosis

For extradural lesions consider:

For intradural extramedullary lesions consider (see also leptomeningeal metastases):

For intradural intramedullary lesions consider:

See also