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Raphaële Charest-Morin, MD, FRCSC,1
Nicolas Dea, MD, MSc, FRCSC,2

1Department of Orthopaedic Surgery, Centre Hospitalier Universitaire de Québec, Laval University, QC.
2Spine Surgeon, Clinical Associate Professor of Neurosurgical and Orthopedic Spine Program, Vancouver General Hospital, University of British Columbia, BC.

CLINICAL TOOLS

Abstract: General practitioners are occasionally confronted to unknown lesions of the spine. Recognition of imaging characteristics and anatomic details from the different imaging modalities generally provides sufficient information to generate an appropriate differential diagnosis. Importantly, first line clinicians should recognize worrisome imaging characteristics and initiate timely referral when indicated. On the other hand, lesions expressing benign features should also be identified to avoid anxiety for the patient and overuse of diagnosis imaging studies. In a public health-care system, judicious utilization of imaging is of paramount importance. This article will review an approach to unknown bony lesions of the spine.
Key Words: Spinal lesion, tumour, imaging characteristics, primary bone tumours.

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A solitary spinal lesion warrants a careful investigation. Most of the time, local imaging and systemic staging provide diagnosis.
In patients over 40 years old, most tumours are malignant with metastases and multiple myeloma being the most frequent. Benign and incidental lesions such as bony islands and hemangiomas are, however, also frequently encountered in this age group.
In patients under 30 years old, tumours of the spine are uncommon and are generally benign with the exception of Ewing Sarcoma and Osteosarcoma.
Primary bone tumours of the spine are rare and should be referred to specialized centers.
Worrisome features on imaging include aggressive bony destruction, spinal canal invasion, soft tissue mass and multiple level involvement.
Pyogenic infections usually start in the disc space, whereas tumours generally spare the intervertebral disc.
Most aggressive lesions will initially present with non-specific clinical complaints and as such, a high level of suspicion is warranted. Systemic symptoms are rare with primary bone tumours.
Most incidental findings do not require any follow-up or further investigation.
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Related Terms: Back Health, Spinal lesion, tumour, imaging characteristics, primary bone tumours
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