Spine and Epidural Space

  • César R. Lacruz
  • Javier Saénz de Santamaría
  • Ricardo H. Bardales
Part of the Essentials in Cytopathology book series (EICP, volume 13)


Neurologic function becomes extremely vulnerable as it funnels through the slender spinal cord and nerve roots. Thus, neoplastic and nonneoplastic processes of the spine and epidural space often give rise to severe backache, radiculopathy, sensorimotor disturbances, loss of sphincter control, and even paraplegia. This clinical scenario, which may suddenly appear, requires an accurate diagnosis that will make possible the proper patient management. Depending on the severity of the symptomatology, the diagnostic approach may be a percutaneous image-guided needle biopsy or an intraoperative consultation in the course of a decompressive laminectomy. In both diagnostic procedures cytologic studies are especially valuable, both for the initial differentiation between inflammation and neoplasia and for the precise identification of the neoplasms found in this region. In this chapter we will consider the cytomorphologic features of the primary and secondary lesions involving the spine and epidural space that threaten the structural and functional integrity of this region of the central nervous system.


Intraoperative assessment Percutaneous image-guided biopsy Cytology Squash preparation Smear preparation Spine Epidural space Spinal cord compression Epidural abscess Vertebral tuberculosis Pott’s disease Vertebral brucellosis Prolapsed disc Epidural lymphoma Vertebral metastasis Myeloma Chordoma Spine bone tumors Vertebral hemangioma Extramedullary hematopoiesis 

Suggested Reading

  1. Aithala JP. Role of percutaneous image guided biopsy in spinal lesions: adequacy and correlation with MRI findings. J Clin Diagn Res. 2016;10:RC11–5.CrossRefGoogle Scholar
  2. Akhtar I, Flowers R, Siddiqi A, Heard K, Baliga M. Fine needle aspiration biopsy of vertebral and paravertebral lesions: retrospective study of 124 cases. Acta Cytol. 2006;50:364–71.CrossRefGoogle Scholar
  3. Alp E, Doganay M. Current therapeutic strategy in spinal brucellosis. Int J Infect Dis. 2008;12:573–7.CrossRefGoogle Scholar
  4. Bilsky MH, Lis E, Raizer J, Lee H, Boland P. The diagnosis and treatment of metastatic spinal tumor. Oncologist. 1999;4:459–69.PubMedGoogle Scholar
  5. Bond A, Manian FA. Spinal epidural abscess: a review with special emphasis on earlier diagnosis. Biomed Res Int. 2016;2016:1614328.CrossRefGoogle Scholar
  6. Chakraborti C, Miller KL. Multiple myeloma presenting as spinal cord compression: a case report. J Med Case Rep. 2010;4:251.CrossRefGoogle Scholar
  7. Cristallini EG, Ascani S, Paganelli C, Peciarolo A, Bolis GB. Role of fine-needle aspiration biopsy in the assessment of sacrococcygeal masses. Diagn Cytopathol. 1991;7:618–21.CrossRefGoogle Scholar
  8. Cugati G, Singh M, Pande A, Ramamurthi R, et al. Primary spinal epidural lymphomas. J Craniovertebr Junction Spine. 2011;2:3–11.CrossRefGoogle Scholar
  9. Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006;355:2012–20.CrossRefGoogle Scholar
  10. Ezenekwe AM, Collins BT, Ponder TB. Fine needle aspiration biopsy of precursor B-cell lymphoblastic lymphoma presenting as a sacral mass. A case report. Acta Cytol. 2004;48:239–42.CrossRefGoogle Scholar
  11. Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011;34:440–54.CrossRefGoogle Scholar
  12. Ghelman B, Lospinuso MF, Levine DB, O’Leary PF, Burke SW. Percutaneous computed-tomography-guided biopsy of the thoracic and lumbar spine. Spine. 1991;16:736–9.CrossRefGoogle Scholar
  13. Gupta S, Takhtani D, Gulati M, Khandelwal N, et al. Sonographically guided fine needle aspiration biopsy of lytic lesions of the spine: technique and indications. J Clin Ultrasound. 1999;27:123–9.CrossRefGoogle Scholar
  14. Kay PA, Nascimento AG, Unni KK, Salomão DR. Chordoma. Cytomorphologic findings in 14 cases diagnosed by fine needle aspiration. Acta Cytol. 2003;47:202–8.CrossRefGoogle Scholar
  15. Kelley SP, Ashford RU, Rao AS, Dickson RA. Primary bone tumors of the spine: a 42-year survey from the Leeds Regional Bone Tumor Registry. Eur Spine J. 2007;16:405–9.CrossRefGoogle Scholar
  16. Monti L, Romano DG, Gozzetti A, Di Pietro G, Miracco C, Cerase A. Myelodysplasia presenting as a thoracic spinal epidural extramedullary hematopoiesis: a rare treatable cause of spinal cord myelopathy. Skelet Radiol. 2012;41:611–4.CrossRefGoogle Scholar
  17. Ozerdemoglu RA, Transfeldt EE, Thompson RC. Lumbosacral chordoma: prognostic factors and treatment. Spine. 1999;24:1639–45.CrossRefGoogle Scholar
  18. Perrin RG, Laxton AW. Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients. Neurosurg Clin N Am. 2004;15:365–73.CrossRefGoogle Scholar
  19. Phadke DM, Lucas DR, Madan S. Fine-needle aspiration biopsy of vertebral and intervertebral disc lesions: specimen adequacy, diagnostic utility, and pitfalls. Arch Pathol Lab Med. 2001;125:1463–8.PubMedGoogle Scholar
  20. Saad RS, Clary KM, Liu Y, Silverman JF, Raab SS. Fine needle aspiration biopsy of vertebral lesions. Acta Cytol. 2004;48:39–46.CrossRefGoogle Scholar
  21. Saenz-Santamaria J, Catalina-Fernandez I. Fine needle aspiration diagnosis of extramedullary hematopoiesis resembling mediastinal and paravesical tumors. Acta Cytol. 2004;48:95–8.CrossRefGoogle Scholar
  22. Salehi SA, Koski T, Ondra SL. Spinal cord compression in beta-thalassemia: case report and review of the literature. Spinal Cord. 2004;42:117–23.CrossRefGoogle Scholar
  23. Sanjay BK, Sim FH, Unni KK, McLeod RA, Klassen RA. Giant cell tumors of the spine. J Bone Joint Surg Br. 1993;75:148–54.CrossRefGoogle Scholar
  24. Spinazzé S, Caraceni A, Schrijvers D. Epidural spinal cord compression. Crit Rev Oncol Hematol. 2005;56:397–406.CrossRefGoogle Scholar
  25. Stoker DJ, Kissin CM. Percutaneous vertebral biopsy: a review of 135 cases. Clin Radiol. 1985;36:569–77.CrossRefGoogle Scholar
  26. Syed R, Bishop JA, Ali SZ. Sacral and presacral lesions: cytopathologic analysis and clinical correlates. Diagn Cytopathol. 2012;40:7–13.CrossRefGoogle Scholar
  27. Tehranzadeh J, Tao C, Browning CA. Percutaneous needle biopsy of the spine. Acta Radiol. 2007;48(8):860–8.CrossRefGoogle Scholar
  28. Tekkök IH, Berker M, Ozcan OE, Ozgen T, Akalin E. Brucellosis of the spine. Neurosurgery. 1993;33:838–44.CrossRefGoogle Scholar
  29. Templin CR, Stambough JB, Stambough JL. Acute spinal cord compression caused by vertebral hemangioma. Spine J. 2004;4:595–600.CrossRefGoogle Scholar
  30. Wang A, Carberry N, Solli E, Gillick J, Islam H, Hillard V. Spinal cord compression secondary to extramedullary hematopoiesis: case report and review of the literature. Case Rep Oncol. 2016;9:290–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • César R. Lacruz
    • 1
  • Javier Saénz de Santamaría
    • 2
  • Ricardo H. Bardales
    • 3
  1. 1.Professor of PathologyComplutense University School of MedicineMadridSpain
  2. 2.Professor of PathologyUniversity Hospital Extremadura, Medical SchoolBadajozSpain
  3. 3.Pathologist, Director Ultrasound-guided Fine Needle Aspiration ServiceOutpatient Pathology Associates / Precision PathologySacramentoUSA

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