Primary Osseous Malignancies of the Spine

Malignant primary vertebral tumours comprise an uncommon group of primary bone malignancies that can pose a diagnostic and therapeutic challenge. The most frequently encountered malignant primary vertebral tumours include chordoma, chondrosarcoma, Ewing sarcoma and osteosarcoma. These tumours often present with nonspecific symptoms, such as back pain, neurologic deficits and spinal instability, which can be confused for the more commonly encountered mechanical back pain and may delay their diagnosis and treatment. Imaging, including radiography, computed tomography (CT) and magnetic resonance imaging (MRI) is crucial for diagnosis, staging, treatment planning and follow-up. Surgical resection remains the mainstay of treatment for malignant primary vertebral tumours, but adjuvant radiotherapy and chemotherapy may be necessary for achieving complete tumour control depending on the type of tumour. In recent years, advances in imaging techniques and surgical approaches, such as en-bloc resection and spinal reconstruction, have improved the outcomes for patients with malignant primary vertebral tumours. However, the management can be complex due to the anatomy involved and the high morbidity and mortality associated with surgery. The different types of malignant primary vertebral lesions will be discussed in this article with an emphasis on the imaging features.

Automated summary

Malignant primary vertebral tumours, including chordoma, chondrosarcoma, Ewing sarcoma and osteosarcoma, present with nonspecific symptoms and can be easily mistaken for mechanical back pain, leading to delayed diagnosis and treatment. Imaging plays a crucial role in diagnosis, staging, treatment planning and follow-up. Surgical resection is the primary treatment, but adjuvant radiotherapy and chemotherapy may be necessary depending on the type of tumour. Advances in imaging techniques and surgical approaches have improved outcomes for patients, but the complexity of management due to anatomy and high morbidity and mortality remains a challenge.