Spine Tumors

Diagnosis uses conventional radiology associated with biopsy. Radiography can detect whether the lesion is osteolitic or osteoblastic and highlight a pathological fracture of the vertebra, CT is usually performed in order to visualize the vessels and the vascularity of the tumor and of the reactive tissues. In bone tumors it shows the extent of the tumor in the vertebra, the extent of the tumor in the soft tissue compartments and extracompartmental spaces and its relatiomship with the vascular bundle and viscera. CT is superior to MRI in showing mineralized tissues. CT is also useful in demostrating the effect of radiation or chemotherapy or local recurrence after a spine resections. MRI is as useful as CT for the local study of vertebral injury. In general, MRI is superior to CT in studyng the soft tissues, the bone marrow and the spine. MRI is also essential in demostrating the effects of chemotherapy or radiation therapy and in monitoring local recurrences after surgery. Angiography shows pathological vascularity and selective arterial embolization has become an indispensable tool to reduce intraoperative bleeding. It is also important to highlight the presence of artery of adamkiewicz. Bone scan and PET are important to localize the lesion and  to differentiate tumors from infectious diseases. Laboratory tests are important for a diagnosis of multiple myeloma (monoclonal protein), osteosarcoma (serum alkaline phosphatase) and Ewing’s sarcoma (lactate dehydrogenase). The indication and execution of the biopsy require knowledge of the clinico-imaging diagnostics, the pathology and the treatment of bone and soft tissue tumors. Because all the tissues potentially contaminated by tumorous cells should be widely included in the definitive surgical removal, the biopsy approach should be placed along the line of the incision which will be used for the surgery. The primary decision in planning the biopsy is whether to perform fine needle biopsy, trocar biopsy, incisional biopsy or excisional biopsy. Fine needle biopsy is the less traumatic and less likely to contaminate tissue planes. It has the highest incidence of false negative. It is mainly used in soft tissue tumors, in local recurrence or metastases, in screening between tumor and infection. Trocar biopsy though scarcely traumatic, it may occasionally cause hematoma with potential contamination of the tissue planes. It allows you to get more material to analyze than fine needle biopsy. The incidence of false negatives is low. Incisional biopsy is indicated in difficult cases, where a detailed histological study on large specimens and the procurement of material for special studies is desired, and in cases where fine needle, trocar biopsy has been unclear. Incisional biopsy must follow very precise rules and meticulous technique. Excisional biopsy can be considered only for conditions whose radiographic pattern is pathognomonic, for example osteoid osteoma. Also in this case one must follow precise rules and meticulous technique.