History and Physical Examination

The most common clinical presentation associated with all spine tumors is back pain that causes the patient to seek medical attention. Back pain is the most frequent symptom for patients with either benign or malignant neoplasms of the spine. Neurologic deficits secondary to compression of the spinal cord or nerve roots also can be part of the presentation.

The degree of neurologic compromise can range from slight weakness or an abnormal reflex to complete paraplegia, depending on the degree of encroachment. The loss of bowel or bladder continence can occur from neurologic compression or can be secondary to a local mass effect from a tumor in the sacrococcygeal region of the spine, as occurs in chordomas. Systemic or constitutional symptoms tend to be more common with malignant or metastatic disease than with benign lesions.

Workup

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Media Gallery

Spinal tumors. Chordoma histology.
Spinal tumors. Higher magnification of chordoma histology demonstrates characteristic physaliferous cells.
Spinal tumors. Aneurysmal bone cyst histology.
Spinal tumors. Coned-down view of lateral thoracic spine in patient with chondrosarcoma.
Spinal tumors. Axial CT scan at level of chondrosarcoma seen on previous x-ray image.
Spinal tumors. T2-weighted MRI scan of chondrosarcoma in same patient.
Spinal tumors. Photograph of patient's back at time of surgery, exhibiting course of definitive incision to excise chondrosarcoma en bloc with previous biopsy tract included with resection.
Spinal tumors. Histology of chondrosarcoma at 40 times magnification.
Spinal tumors. Lateral cervical spine x-ray demonstrating osteoblastoma in posterior elements of C3 and C4.
Spinal tumors. MRI of osteoblastoma in posterior elements of C3 and C4 seen on previous x-ray image.
Spinal tumors. Histology of osteoblastoma at low magnification.
Spinal tumors. Higher magnification of osteoblastoma.
Spinal tumors. Coned-down view of hemangioma in thoracic spine.
Spinal tumors. Axial CT scan of hemangioma in lumbar vertebra.
Spinal tumors. Axial CT scan of thoracic vertebra, which demonstrates nidus of osteoid osteoma in posterior elements.

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Author

Andrew A Sama, MD Associate Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College; Associate Attending Orthopedic Surgeon, Associate Director of Spine Surgery Fellowship, Hospital for Special Surgery; Associate Attending Orthopedic Surgeon, New York-Presbyterian Hospital

Andrew A Sama, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: DePuy Spine; Clariance, Inc.<br/>Received royalty from Orthodevelopment Corporation for implant design & development; Received consulting fee from DePuy Synthes for consulting; Received royalty from Pagoda Pedicle Screw System for inventor/designer; Received consulting fee from Clariance, Inc. for advisory board/consultant; Received ownership interest from Paradigm Spine, LLC, and Sentio LLC for investment interest; Received grant/research funds from Spinal Kinetics for principal investigation paid to institution.

Coauthor(s)

William D Zelenty, MD Assistant Attending Surgeon, Hospital for Special Surgery; Assistant Professor of Orthopaedic Surgery, Weill Cornell Medical College

William D Zelenty, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Cervical Spine Research Society, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society for Minimally Invasive Spine Surgery

Disclosure: Nothing to disclose.

Darren R Lebl, MD Clinical Instructor of Spinal Surgery, Weill Cornell Medical College of Cornell University; Assistant Attending Orthopaedic Surgeon, Hospital for Special Surgery

Darren R Lebl, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association of Neurological Surgeons, North American Spine Society, Scoliosis Research Society

Disclosure: Nothing to disclose.

Federico P Girardi, MD Associate Professor of Orthopaedic Surgery, Weill Medical College of Cornell University; Associate Attending Orthopaedic Surgeon, The Hospital for Special Surgery; Director of Research, Spinal Surgical Service, The Hospital for Special Surgery

Federico P Girardi, MD is a member of the following medical societies: Medical Society of the State of New York

Disclosure: Nothing to disclose.

Frank P Cammisa, MD Chief, Spine Service, Associate Attending Orthopedic Surgeon, Assistant Scientist, Research Division, Hospital for Special Surgery; Associate Professor, Department of Surgery (Orthopedics), Weill Cornell Medical College; Assistant Attending Surgeon, New York Hospital

Frank P Cammisa, MD is a member of the following medical societies: American Association for the Advancement of Science, American Medical Association, American Spinal Injury Association, Eastern Orthopaedic Association, Medical Society of the State of New York, New York Academy of Sciences, New York County Medical Society, North American Spine Society

Disclosure: Received royalty from Nuvasive, Inc. for consulting; Received consulting fee from Alphatec Spine, Inc., Centinel Spine, Inc., Disc Motion Technologies, Inc., Healthpoint Capital Partners, LP., IVY Healthcare Partners, LP., Mazor Surgical Technologies, Nuvasive, Inc. Orthogem, Ltd., Orthovita Inc., Paradigm Spine, LLC., Spinal Kinetics, Spinal Partners III, Viscogliosi Brothers, LLC. for consulting; Received ownership interest from Alphatec Spine, Inc., BI Members, LLC, Centinal Spine, Inc., Dis.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Jeffrey A Goldstein, MD Clinical Professor of Orthopedic Surgery, New York University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center

Jeffrey A Goldstein, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, AOSpine, Cervical Spine Research Society, International Society for the Advancement of Spine Surgery, International Society for the Study of the Lumbar Spine, Lumbar Spine Research Society, North American Spine Society, Scoliosis Research Society, Society of Lateral Access Surgery

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Globus, 3Spine<br/>Received income in an amount equal to or greater than $250 from: Globus, Nuvasive, Surgalign, 3Spine.

Additional Contributors

Lee H Riley III, MD Chief, Division of Orthopedic Spine Surgery, Associate Professor, Departments of Orthopedic Surgery and Neurosurgery, Johns Hopkins University School of Medicine

Disclosure: Nothing to disclose.

William O Shaffer, MD Former Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons

William O Shaffer, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Association, International Society for the Study of the Lumbar Spine, Kentucky Medical Association, Kentucky Orthopaedic Society, North American Spine Society, Southern Medical Association, Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Spinal Tumors Clinical Presentation

History and Physical Examination

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