Metastatic spine disease: epidemiology, pathophysiology, and evaluation of patients

Metastatic tumors are the most common neoplasms of the spine and represent an ominous extension of systemic cancer. Local back or neck pain is the earliest and most common presentation and is all too often initially dismissed as back or neck strain or slipped disk. It is axiomatic that a cancer patient with new-onset neck or back pain harbors spinal metastasis until proven otherwise. Pain is followed by weakness, numbness, and sphincter dysfunction, all of which progresses relentlessly to complete and irreversible paralysis unless timely treatment is undertaken. Plain radiographs provide a simple and useful screening test. MRI imaging is the imaging method of choice. Percutaneous image-guided spine biopsy has become a useful test to establish a tissue diagnosis.