Advertisement

Primary Tumors of the Spine

  • Rex C. Haydon
  • Frank M. Phillips
Part of the Current Clinical Oncology book series (CCO)

Abstract

Primary neoplasms of the spine encompass a broad spectrum of tumors, ranging in their tissue of origin, local behavior, and potential for metastasis. The diagnosis and treatment of these disorders is accordingly varied. As a category, non-myeloproliferative primary tumors of the spine are rare, accounting for approx 5% of all bone tumors, when one excludes hemangiomas (1,2). In frequency, therefore, they are much less common than metastatic and/or myeloproliferative neoplasms involving the spine, as well as non-neoplastic processes such as infection, metabolic disorders, and other pathologies. The diagnosis of primary tumors of the spine, therefore, must occur with careful consideration of other more common entities. In this chapter, we discuss the common benign and malignant tumors that afflict the spinal column, and describe the appropriate algorithm for evaluating and treating these conditions.

Keywords

Fibrous Dysplasia Giant Cell Tumor Osteoid Osteoma Aneurysmal Bone Cyst Primary Bone Tumor 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Weinstein JN, McLain RF. Primary tumors of the spine. Spine 1987; 12:843–851.PubMedCrossRefGoogle Scholar
  2. 2.
    Masaryk TJ. Neoplastic disease of the spine. Radiol Clin North Am 1991; 29:829–845.PubMedGoogle Scholar
  3. 3.
    Haibach H, Farrell C, Gaines RW. Osteoid osteoma of the spine: surgically correctable cause of painful scoliosis. CMAJ 1986; 135:895–899.PubMedGoogle Scholar
  4. 4.
    Pettine KA, Klassen RA. Osteoid-osteoma and osteoblastoma of the spine. J Bone Joint Surg Am 1986; 68:354–361.PubMedGoogle Scholar
  5. 5.
    Janin Y, Epstein JA, Carras R, Khan A. Osteoid osteomas and osteoblastomas of the spine. Neurosurgery 1981; 8:31–38.PubMedCrossRefGoogle Scholar
  6. 6.
    Park YK, Ryu KN, Han CS, Bae DK. Multifocal, metachronous giant-cell tumor of the ulna. A case report. J Bone Joint Surg Am 1999; 81:409–413.PubMedGoogle Scholar
  7. 7.
    Kos CB, Taconis WK, Fidler MW, ten Velden JJ. Multifocal giant cell tumors in the spine. A case report. Spine 1997; 22:821–822.PubMedCrossRefGoogle Scholar
  8. 8.
    Damron TA, Sim FH, Unni KK. Multicentric chondrosarcomas. Clin Orthop 1996:211–219.Google Scholar
  9. 9.
    Enneking WF, Kagan A. The implications of “skip” metastases in osteosarcoma. Clin Orthop 1975:33–41.Google Scholar
  10. 10.
    Enneking WF, Kagan A. “Skip” metastases in osteosarcoma. Cancer 1975; 36:2192–2205.PubMedCrossRefGoogle Scholar
  11. 11.
    Wuisman P, Enneking WF. Prognosis for patients who have osteosarcoma with skip metastasis. J Bone Joint Surg Am 1990; 72:60–68.PubMedGoogle Scholar
  12. 12.
    Enneking WF. Staging of musculoskeletal tumors. In: F EW, ed. Musculoskeletal tumor surgery. New York, NY: Churchill Livingstone; 1983:87.Google Scholar
  13. 13.
    Kay RM, Eckardt JJ, Seeger LL, Mirra JM, Hak DJ. Pulmonary metastasis of benign giant cell tumor of bone. Six histologically confirmed cases, including one of spontaneous regression. Clin Orthop 1994:219–30.Google Scholar
  14. 14.
    Huvos AG. “Benign” metastasis in giant cell tumor of bone. Hum Pathol 19 1981; 12:1151Google Scholar
  15. 15.
    Ramappa AJ, Lee FY, Tang P, Carlson JR, Gebhardt MC, Mankin HJ. Chondroblastoma of bone. J Bone Joint Surg Am 2000; 82A:1140–1145.Google Scholar
  16. 16.
    Birch PJ, Buchanan R, Golding P, Pringle JA. Chondroblastoma of the rib with widespread bone metastases. Histopathology 1994; 25:583–585.PubMedCrossRefGoogle Scholar
  17. 17.
    Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop 1980:106–120.Google Scholar
  18. 18.
    Hart RA, Boriani S, Biagini R, Currier B, Weinstein JN. A system for surgical staging and management of spine tumors. A clinical outcome study of giant cell tumors of the spine. Spine 1997; 22:1773–1783.PubMedCrossRefGoogle Scholar
  19. 19.
    Jose Alcaraz Mexia M, Izquierdo Nunez E, Santonja Garriga C, Maria Salgado Salinas R. Osteochondroma of the thoracic spine and scoliosis. Spine 2001; 26:1082–1085.PubMedCrossRefGoogle Scholar
  20. 20.
    Roblot P, Alcalay M, Cazenave-Roblot F, Levy P, Bontoux D. Osteochondroma of the thoracic spine. Report of a case and review of the literature. Spine 1990; 15:240–243.PubMedCrossRefGoogle Scholar
  21. 21.
    Albrecht S, Crutchfield JS, SeGall GK. On spinal osteochondromas. J Neurosurg 1992; 77:247–252.PubMedCrossRefGoogle Scholar
  22. 22.
    Khosla A, Martin DS, Awwad EE. The solitary intraspinal vertebral osteochondroma. An unusual cause of compressive myelopathy: features and literature review. Spine 1999; 24:77–81.PubMedCrossRefGoogle Scholar
  23. 23.
    Weinstein JN, McLain RF. Tumors of the Spine. In: Rothman RH, Simeone FA, eds. The Spine. Vol. 2. Philadelphia, PA: W. B. Saunders Company; 1992:1279–1318.Google Scholar
  24. 24.
    Willms R, Hartwig CH, Bohm P, Sell S. Malignant transformation of a multiple cartilaginous exostosis-a case report. Int Orthop 1997; 21:133–136.PubMedCrossRefGoogle Scholar
  25. 25.
    Norman A, Sissons HA. Radiographic hallmarks of peripheral chondrosarcoma. Radiology 1984; 151:589–596.PubMedGoogle Scholar
  26. 26.
    Silberstein MJ, Sundaram M, Akbarnia B, Luisiri A, McGuire M. Eosinophilic granuloma of the spine. Orthopedics 1985; 8:264, 267–74.PubMedGoogle Scholar
  27. 27.
    Nesbit ME, Kieffer S, D’Angio GJ. Reconstitution of vertebral height in histiocytosis X: a long-term follow-up. J Bone Joint Surg Am 1969; 51:1360–1368.PubMedGoogle Scholar
  28. 28.
    Seimon LP. Eosinophil granuloma of the spine. J Pediatr Orthop 1981; 1:371–376.PubMedGoogle Scholar
  29. 29.
    Green NE, Robertson WW, Jr., Kilroy AW. Eosinophilic granuloma of the spine with associated neural deficit. Report of three cases. J Bone Joint Surg Am 1980; 62:1198–1202.PubMedGoogle Scholar
  30. 30.
    Schajowicz F, Slullitel J. Eosinophilic granuloma of bone and its relationship to Hand-Schuller-Christian and Letterer-Siwe syndromes. J Bone Joint Surg Br 1973; 55:545–565.PubMedGoogle Scholar
  31. 31.
    Islinger RB, Kuklo TR, Owens BD, et al. Langerhans’ cell histiocytosis in patients older than 21 years. Clin Orthop 2000:231–235.Google Scholar
  32. 32.
    Vogel JM, Vogel P. Idiopathic histiocytosis: a discussion of eosinophilic granuloma, the Hand-Schuller-Christian syndrome, and the Letterer-Siwe syndrome. Semin Hematol 1972; 9:349–369.PubMedGoogle Scholar
  33. 33.
    Singer FR. Paget’s Disease of Bone. Topics in Bone and Mineral Disorders. New York, NY: Plenum Medical Book Co; 1977.Google Scholar
  34. 34.
    Altman RD, Bloch DA, Hochberg MC, Murphy WA. Prevalence of pelvic Paget’s disease of bone in the United States. J Bone Miner Res 2000; 15:461–465.PubMedCrossRefGoogle Scholar
  35. 35.
    Meunier PJ, Salson C, Mathieu L, et al. Skeletal distribution and biochemical parameters of Paget’s disease. Clin Orthop 1987:37–44.Google Scholar
  36. 36.
    Noor M, Shoback D. Paget’s disease of bone: diagnosis and treatment update. Curr Rheumatol Rep 2000; 2:67–73.PubMedCrossRefGoogle Scholar
  37. 37.
    Moore TE, King AR, Kathol MH, el-Khoury GY, Palmer R, Downey PR. Sarcoma in Paget disease of bone: clinical, radiologic, and pathologic features in 22 cases. AJR Am J Roentgenol 1991; 156:1199–1203.PubMedGoogle Scholar
  38. 38.
    Lichtenstein L. Polyostotic fibrous dysplasia. Arch Surg 1938; 36:874–898.Google Scholar
  39. 39.
    Lichtenstein L, Jaffe HL. Fibrous dysplasia of bone. Arch Pathol 1942; 33:777–816.Google Scholar
  40. 40.
    Chow LT, Griffith J, Chow WH, Kumta SM. Monostotic fibrous dysplasia of the spine: report of a case involving the lumbar transverse process and review of the literature. Arch Orthop Trauma Surg 2000; 120:460–464.PubMedCrossRefGoogle Scholar
  41. 41.
    Wright JF, Stoker DJ. Fibrous dysplasia of the spine. Clin Radiol 1988; 39:523–527.PubMedCrossRefGoogle Scholar
  42. 42.
    Hammami MM, al-Zahrani A, Butt A, Vencer LJ, Hussain SS. Primary hyperparathyroidism-associated polyostotic fibrous dysplasia: absence of McCune-Albright syndrome mutations. J Endocrinol Invest 1997; 20:552–558.PubMedGoogle Scholar
  43. 43.
    Danon M, Robboy SJ, Kim S, Scully R, Crawford JD. Cushing syndrome, sexual precocity, and polyostotic fibrous dysplasia (Albright syndrome) in infancy. J Pediatr 1975; 87:917–921.PubMedCrossRefGoogle Scholar
  44. 44.
    Cohen MM, Jr., Howell RE. Etiology of fibrous dysplasia and McCune-Albright syndrome. Int J Oral Maxillofac Surg 1999; 28:366–371.PubMedCrossRefGoogle Scholar
  45. 45.
    Nabarro MN, Giblin PE. Monostotic fibrous dysplasia of the thoracic spine. Spine 1994; 19:463–465.PubMedCrossRefGoogle Scholar
  46. 46.
    Rodenberg J, Jensen OM, Keller J, Nielsen OS, Bunger C, Jurik AG. Fibrous dysplasia of the spine, costae and hemipelvis with sarcomatous transformation. Skeletal Radiol 1996; 25:682–684.PubMedCrossRefGoogle Scholar
  47. 47.
    Koci TM, Mehringer CM, Yamagata N, Chiang F. Aneurysmal bone cyst of the thoracic spine: evolution after particulate embolization. AJNR Am J Neuroradiol 1995; 16:857–860.PubMedGoogle Scholar
  48. 48.
    Kransdorf MJ, Sweet DE. Aneurysmal bone cyst: concept, controversy, clinical presentation, and imaging. AJR Am J Roentgenol 1995; 164:573–580.PubMedGoogle Scholar
  49. 49.
    Sanerkin NG, Mott MG, Roylance J. An unusual intraosseous lesion with fibroblastic, osteoclastic, osteoblastic, aneurysmal and fibromyxoid elements. “Solid” variant of aneurysmal bone cyst. Cancer 1983; 51:2278–2286PubMedCrossRefGoogle Scholar
  50. 50.
    Cory DA, Fritsch SA, Cohen MD, et al. Aneurysmal bone cysts: imaging findings and embolotherapy. AJR Am J Roentgenol 1989; 153:369–373.PubMedGoogle Scholar
  51. 51.
    Huvos AG. Bone Tumors: Diagnosis, Treatment, and Prognosis. Philadelphia, PA: Saunders; 1991.Google Scholar
  52. 52.
    Robbins LR, Fountain EN. Hemangioma of cervical vertebras with spinal cord compression. N Engl J Med 1958; 258:685–687.PubMedGoogle Scholar
  53. 53.
    Healy M, Herz DA, Pearl L. Spinal hemangiomas. Neurosurgery 1983; 13:689–691.PubMedCrossRefGoogle Scholar
  54. 54.
    Glanzmann C, Rust M, Horst W. [Irradiation therapy of vertebral angionomas: results in 62 patients during the years 1939 to 1975 (author’s transl)]. Strahlentherapie 1977; 153:522–525.PubMedGoogle Scholar
  55. 55.
    Faria SL, Schlupp WR, Chiminazzo H, Jr. Radiotherapy in the treatment of vertebral hemangiomas. Int J Radiat Oncol Biol Phys 1985; 11:387–390.PubMedGoogle Scholar
  56. 56.
    Hekster RE, Endtz LJ. Spinal-cord compression caused by vertebral haemangioma relieved by percutaneous catheter embolisation: 15 years later. Neuroradiology 1987; 29:101.PubMedCrossRefGoogle Scholar
  57. 57.
    Hekster RE, Luyendijk W, Tan TI. Spinal-cord compression caused by vertebral haemangioma relieved by percutaneous catheter embolisation. Neuroradiology 1972; 3:160–164.PubMedCrossRefGoogle Scholar
  58. 58.
    Greenspan A. Benign bone-forming lesions: osteoma, osteoid osteoma, and osteoblastoma. Clinical, imaging, pathologic, and differential considerations. Skeletal Radiol 1993; 22:485–500.PubMedGoogle Scholar
  59. 59.
    Azouz EM, Kozlowski K, Marton D, Sprague P, Zerhouni A, Asselah F. Osteoid osteoma and osteoblastoma of the spine in children. Report of 22 cases with brief literature review. Pediatr Radiol 1986; 16:25–31.PubMedCrossRefGoogle Scholar
  60. 60.
    Mehta MH. Pain provoked scoliosis. Observations on the evolution of the deformity. Clin Orthop 1978:58–65.Google Scholar
  61. 61.
    Gamba JL, Martinez S, Apple J, Harrelson JM, Nunley JA. Computed tomography of axial skeletal osteoid osteomas. AJR Am J Roentgenol 1984; 142:769–772.PubMedGoogle Scholar
  62. 62.
    Ward WG, Eckardt JJ, Shayestehfar S, Mirra J, Grogan T, Oppenheim W. Osteoid osteoma diagnosis and management with low morbidity. Clin Orthop 1993:229–235.Google Scholar
  63. 63.
    Ransford AO, Pozo JL, Hutton PA, Kirwan EO. The behaviour pattern of the scoliosis associated with osteoid osteoma or osteoblastoma of the spine. J Bone Joint Surg Br 1984; 66:16–20.PubMedGoogle Scholar
  64. 64.
    Poey C, Clement JL, Baunin C, et al. Percutaneous extraction of an osteoid osteoma of the lumbar spine under CT guidance. J Comput Assist Tomogr 1991; 15:1056–1058.PubMedCrossRefGoogle Scholar
  65. 65.
    Osti OL, Sebben R. High-frequency radio-wave ablation of osteoid osteoma in the lumbar spine. Eur Spine J 1998; 7:422–425.PubMedCrossRefGoogle Scholar
  66. 66.
    Kroon HM, Schurmans J. Osteoblastoma: clinical and radiologic findings in 98 new cases. Radiology 1990; 175:783–790.PubMedGoogle Scholar
  67. 67.
    Lucas DR, Unni KK, McLeod RA, O’Connor MI, Sim FH. Osteoblastoma: clinicopathologic study of 306 cases. Hum Pathol 1994; 25:117–134.PubMedCrossRefGoogle Scholar
  68. 68.
    McLeod RA, Dahlin DC, Beabout JW. The spectrum of osteoblastoma. Am J Roentgenol 1976; 126:321–325.Google Scholar
  69. 69.
    Marsh BW, Bonfiglio M, Brady LP, Enneking WF. Benign osteoblastoma: range of manifestations. J Bone Joint Surg Am 1975; 57:1–9.PubMedGoogle Scholar
  70. 70.
    Sypert GW. Osteoid osteoma and osteoblastoma of the spine. In: Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI, eds. Tumors of the Spine: Diagnosis and Clinical Management. Vol. 1. Philadelphia, PA: W. B. Saunders Company; 1990:117–127.Google Scholar
  71. 71.
    Mayer L. Malignant degeneration of so-called benign osteoblastoma. Bull Hosp Joint Dis 1967; 28:4–13.PubMedGoogle Scholar
  72. 72.
    Schwimer SR, Bassett LW, Mancuso AA, Mirra JM, Dawson EG. Giant cell tumor of the cervicothoracic spine. AJR Am J Roentgenol 1981; 136:63–67.PubMedGoogle Scholar
  73. 73.
    Smith J, Wixon D, Watson RC. Giant-cell tumor of the sacrum. Clinical and radiologic features in 13 patients. J Can Assoc Radiol 1979; 30:34–39.PubMedGoogle Scholar
  74. 74.
    Bidwell JK, Young JW, Khalluff E. Giant cell tumor of the spine: computed tomography appearance and review of the literature. J Comput Tomogr 1987; 11:307–311.PubMedCrossRefGoogle Scholar
  75. 75.
    Campanacci M, Boriani S, Giunti A. Giant cell tumors of the spine. In: Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI, eds. Tumors of the Spine: Diagnosis and Clinical Management. Philadelphia, PA: W. B. Saunders Company; 1990:163–172.Google Scholar
  76. 76.
    Fidler MW. Surgical treatment of giant cell tumours of the thoracic and lumbar spine: report of nine patients. Eur Spine J 2001; 10:69–77.PubMedCrossRefGoogle Scholar
  77. 77.
    Laus M, Zappoli FA, Malaguti MC, Alfonso C. Intralesional surgery of primary tumors of the anterior cervical column. Chir Organi Mov 1998; 83:43–51.PubMedGoogle Scholar
  78. 78.
    Misasi N, Sadile F. Selective arterial embolization in orthopaedic pathology. Analysis of long-term results. Chir Organi Mov 1991; 76:311–316.PubMedGoogle Scholar
  79. 79.
    Leung LY, Shu SJ, Chan MK, Chan CH. Chondroblastoma of the lumbar vertebra. Skeletal Radiol 2001; 30:710–713.PubMedCrossRefGoogle Scholar
  80. 80.
    Kurth AA, Warzecha J, Rittmeister M, Schmitt E, Hovy L. Recurrent chondroblastoma of the upper thoracic spine. A case report and review of the literature. Arch Orthop Trauma Surg 2000; 120:544–547.PubMedCrossRefGoogle Scholar
  81. 81.
    Barwick KW, Huvos AG, Smith J. Primary osteogenic sarcoma of the vertebral column: a clinicopathologic correlation of ten patients. Cancer 1980; 46:595–604.PubMedCrossRefGoogle Scholar
  82. 82.
    Shives TC, Dahlin DC, Sim FH, Pritchard DJ, Earle JD. Osteosarcoma of the spine. J Bone Joint Surg Am 1986; 68:660–668.PubMedGoogle Scholar
  83. 83.
    Sundaresan N, Schiller AL, Rosenthal DI. Osteosarcoma of the spine. In: Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI, eds. Tumors of the Spine: Diagnosis and Clinical Management. Philadelphia, PA: W. B. Saunders Company; 1990:128–145.Google Scholar
  84. 84.
    Ozaki T, Flege S, Liljenqvist U, et al. Osteosarcoma of the spine: experience of the Cooperative Osteosarcoma Study Group. Cancer 2002; 94:1069–1077.PubMedCrossRefGoogle Scholar
  85. 85.
    Hirsh LF, Thanki A, Spector HB. Primary spinal chondrosarcoma with eighteen-year follow-up: case report and literature review. Neurosurgery 1984; 14:747–749.PubMedCrossRefGoogle Scholar
  86. 86.
    Shives TC, McLeod RA, Unni KK, Schray MF. Chondrosarcoma of the spine. J Bone Joint Surg Am 1989; 71:1158–1165.PubMedGoogle Scholar
  87. 87.
    Aprin H, Riseborough EJ, Hall JE. Chondrosarcoma in children and adolescents. Clin Orthop 1982:226–232.Google Scholar
  88. 88.
    Bergh P, Gunterberg B, Meis-Kindblom JM, Kindblom LG. Prognostic factors and outcome of pelvic, sacral, and spinal chondrosarcomas: a center-based study of 69 cases. Cancer 2001; 91:1201–1212.PubMedCrossRefGoogle Scholar
  89. 89.
    Camins MB, Duncan AW, Smith J, Marcove RC. Chondrosarcoma of the spine. Spine 1978; 3:202–209.PubMedCrossRefGoogle Scholar
  90. 90.
    Habrand JL, Schlienger P, Schwartz L, et al. Clinical applications of proton therapy. Experiences and ongoing studies. Radiat Environ Biophys 1995; 34:41–44.PubMedCrossRefGoogle Scholar
  91. 91.
    Dahlin DC, Unni KK. Bone Tumors: General Aspects and Data on 8,542 Cases. Springfield, IL: Thomas; 1986.Google Scholar
  92. 92.
    Pilepich MV, Vietti TJ, Nesbit ME, et al. Ewing’s sarcoma of the vertebral column. Int J Radiat Oncol Biol Phys 1981; 7:27–31.PubMedGoogle Scholar
  93. 93.
    Kornberg M. Primary Ewing’s sarcoma of the spine. A review and case report. Spine 1986; 11:54–57.PubMedCrossRefGoogle Scholar
  94. 94.
    Sharafuddin MJ, Haddad FS, Hitchon PW, Haddad SF, el-Khoury GY. Treatment options in primary Ewing’s sarcoma of the spine: report of seven cases and review of the literature. Neurosurgery 1992; 30:610–619.PubMedCrossRefGoogle Scholar
  95. 95.
    Venkateswaran L, Rodriguez-Galindo C, Merchant TE, Poquette CA, Rao BN, Pappo AS. Primary Ewing tumor of the vertebrae: clinical characteristics, prognostic factors, and outcome. Med Pediatr Oncol 2001; 37:30–35.PubMedCrossRefGoogle Scholar
  96. 96.
    Eriksson B, Gutenberg B, G. KL. Chordoma. A clinico-pathologic and prognostic study of a Swedish national series. Acta Orthop Scand 1958; 52:49–58.Google Scholar
  97. 97.
    Meyer JE, Lepke RA, Lindfors KK, et al. Chordomas: their CT appearance in the cervical, thoracic and lumbar spine. Radiology 1984; 153:693–696.PubMedGoogle Scholar
  98. 98.
    Bjornsson J, Wold LE, Ebersold MJ, Laws ER. Chordoma of the mobile spine. A clinicopathologic analysis of 40 patients. Cancer 1993; 71:735–740.PubMedCrossRefGoogle Scholar
  99. 99.
    Sundaresan N. Chordomas. Clin Orthop 1986:135–142.Google Scholar
  100. 100.
    Munzenrider JE, Liebsch NJ. Proton therapy for tumors of the skull base. Strahlenther Onkol 1999; 175:57–63.PubMedCrossRefGoogle Scholar
  101. 101.
    Sundaresan N, Rosenthal DI, Schiller AL, Krol G. Chordomas. In: Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI, eds. Tumors of the Spine: Diagnosis and Clinical Management. Philadelphia, PA: W. B. Saunders Company; 1990:192–213.Google Scholar
  102. 102.
    Mindell ER. Chordoma. J Bone Joint Surg Am 1981; 63:501–505.PubMedGoogle Scholar

Copyright information

© Humana Press, Inc., Totowa, NJ 2006

Authors and Affiliations

  • Rex C. Haydon
    • 1
  • Frank M. Phillips
    • 2
  1. 1.Section of Orthopaedic Surgery and Rehabilitation Medicine, Department of SurgeryUniversity of Chicago HospitalsChicago
  2. 2.Department of Orthopaedic SurgeryRush University Medical CenterChicago

Personalised recommendations