Epidemiology Of Spinal Tumors

Michel Benoist

Thibaud Lenoir

Pierre Guigui

Spinal Tumors May Arise From Primary Local Lesions Or From Distant Malignancies, Spreading To The Spine. The Majority Of Lesions Are Metastatic Tumors, Far More Common Than Primary Lesions. The Management Of Malignant Secondaries Is Different From That Used In Primary Tumors, As These Lesions, Both Benign And Malignant, Are Frequently Curable. This Chapter Focuses On The Basic Descriptive Studies Of The Distribution And Progression Of Spinal Tumors In Populations, With Occasional References To Studies Of Etiologic Hypotheses. Local Involvement Of The Spine May Result From Primary Tumors Of Bone Or From Primary Lesions Arising In The Spinal Cord Or In Its Coverings. The First Part Of This Chapter Considers The Primary Lesions. The Metastatic Tumors Are Discussed Subsequently.

PRIMARY TUMORS

Primary Tumors Of The Spine Are Very Rare. They May Develop In Three Locations: Intramedullary, Intradural-extramedullary, Or Extradurally.

Extradural Bone Tumors

Extradural Tumors Comprise Principally Primary Bone Tumors, Nonosseous Extradural Primary Tumors Being Exceptional. Their Relative Incidence Reflects That Of The Skeleton In General. Certain Tumors (chordoma, Osteoblastoma) Show A Predilection For The Spinal Column, But They Represent A Small Proportion Of Spinal Tumors. The Classification Used In This Chapter Is Similar To That Advocated By Lichtenstein For Bone Tumors. This Classification Is Based On Histologic Findings And Differentiates Hematopoietic Tumors, Chondrogenic Tumors, Osteogenic Tumors, Tumors Of Unknown Origin, Fibrogenic Tumors, And Notochordal Tumors.

BENIGN PRIMARY BONE TUMORS

Chondrogenic Tumors

Osteochondroma

Spinal Localization Represents Approximately 7% Of This Common Benign Tumor. It Is Usually Observed In Young Patients Younger Than 20 Years, Affecting Predominantly
The Lumbar Spine, Followed By Thoracic Sacrum And Cervical Spine. In The Mayo Clinic Series, This Tumor Composes 22% Of Benign Spinal Tumors And 8% Of All Spine Tumors (7).

Chondroma

Its Typical Localization Is On The Hands And Feet. Composed Of Mature Cartilage, The Spinal Localization Is Rare, Representing Approximately 4% Of All Chondromas And 5.7% Of The Benign Spinal Tumors Disclosed In Dahlin’s Series (7).

Chondroblastoma And Chondromyxoid Fibroma

These Tumors Are Rare. They Are Even More Exceptional In The Spine. They Represent Approximately 1% Of The Benign Spinal Tumors, Usually Occurring In The Second Decade Of Life (7).

Osteogenic Tumors

Osteoid Osteoma

Osteoid Osteomas Represent Approximately 9% Of All Benign Spinal Tumors. They Are Usually Located In The Posterior Arch Of The Vertebrae And Encountered In The Second Decade Of Age, With A Male Predominance (7).

Benign Osteoblastoma

This Tumor Is Observed Predominantly In The Spine, During The First 3 Decades Of Life. Different From Osteoid Osteoma In Its Size And The Absence Of Peripheral Sclerotic Bone, It Represents 12% Of All Benign Primary Tumors Of The Mayo Clinic Series (7) And 22% Of Weinstein’s Cases (39).

Tumors Of Unknown Origin

Giant Cell Tumor

This Tumor Can Produce Metastasis, Although It Is Cytologically Benign. In The Spine, Sacrum Location Is Predominant, Occurring More Frequently In Women During The Third And Fourth Decades Of Life. Giant Cell Tumors Represent 16% Of All Benign Spinal Tumors In Weinstein’s Series (39) And 67% Of The Sacral Benign Tumors Reported By Dahlin (7). Local Postoperative Recurrences May Occur With This Type Of Tumor.

Fibrous Histiocytoma

Fibrous Histiocytoma Is An Exceptional Benign Spinal Tumor. Seven Cases Have Been Reported In The Literature.

Other Benign Tumors

Hemangioma

Hemangioma Is A Frequent Asymptomatic Tumor Of The Spine, Representing 10% Of Benign Lesions Encountered In Adults, With A Female Predominance (7).

Aneurysmal Bone Cyst

The Cysts Have A High Propensity For The Spine. Spinal Localization Represents Approximately 30% Of This Type Of Tumor, Occurring Principally In Adolescents And Young Adults. In Dahlin’s Series, Its Incidence Was 2% Of All Spinal Tumors (15).

MALIGNANT PRIMARY TUMORS

Hematopoietic Tumors

Hematopoietic Tumors Comprise Lymphoma, Solitary Plasmacytoma, And Myeloma. Lymphoma (23) May Present As A Systematic Disease With Skeletal Manifestations, Or As An Isolated Bone Tumor. This Neoplasm Can Occur At Any Age But Is Rare In Children. Spine Localization Is Not Exceptional. Five Cases Of 51 Malignant Primary Spinal Tumors Are Disclosed In Weinstein’s Series (39). Dahlin (7) Reported 46 Cases In 542 Patients. The Thoracic Spine Is Predominantly Affected Followed By The Sacrum And The Lumbar And Cervical Spine.

Solitary Plasmocytoma (25) And Myeloma (10) Are The Most Frequent Malignant Primary Tumors. Spinal Localization Represents 27% Of All Spine Primary Tumors And 34% Of Malignant Primary Tumors In The Mayo Clinic Series (7). Solitary Spinal Plasmocytomas Compose 29% Of Malignant Primary Tumors In Weinstein’s Report (39). The Thoracic Spine Is The Most Common Site, Followed By The Lumbar And Cervical Spine. They Predominate In Men And Are Rare Before The Fifth Decade.

Chondrosarcoma

Chondrosarcomas Can Be Primary Or Secondary To Osteochondromas. They Occur In Adults, With A Male Predominance, Representing Approximately 10% Of Malignant Spinal Tumors. An Adequate Control Of The Disease Is Mandatory To Prevent Recurrences.

Osteosarcoma

The Spinal Localization Affects Primarily The Sacrum, Followed By Lumbar, Dorsal, And Cervical Spine. Principally Observed In Young Male Patients, It Represents Approximately 10% Of Malignant Spinal Tumors (7).

Ewing Tumor

Spinal Localization Is Rare (5% Of Malignant Bone Tumors). It Is Principally Encountered In The Second Decade Of Life, With A Male Predominance. The Sacrum Is The Usual Site, Followed By The Lumbar, Thoracic, And Cervical Spine (30).

Malignant Giant Cell Tumor

Malignancy Can Be Primary Or After Treatment Of A Benign Giant Cell Tumor. Spinal Location Is Rare (0.4% Of Malignant Spine Tumors), Occurring During The Third Or Fourth Decade Of Life.

Chordoma

Chordomas Develop From The Remains Of The Primitive Notochord. They Have A High Propensity For The Distal End Of The Spinal Column, Affecting The Sacrococcygeal Area In
One Half Of The Patients, Usually Males Younger Than 30 Years. They Represent 30% Of Malignant Spinal Tumors (7).

Fibrosacroma

Fibrosarcomas Are Rare (3% Of Malignant Spinal Tumors) With No Sex Predominance, Affecting Mainly The Sacrum. The Age Distribution Is Linear Through The Second To The Sixth Decade (7).

Intradural Tumors

Intradural Spinal Tumors Are Less Common Than Brain Tumors. Their Annual Incidence Is Estimated To Be 2.5 Per 100,000 (14). The Epidemiologic Description Is Divided Into Intramedullary Tumors And Extramedullary Intradural Tumors.

Intramedullary Spinal Gliomas

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