Spinal tumours: diagnosis, clinical presentation and principles of treatment

Spinal tumours can be categorized as primary or metastatic. Primary neoplasms of the spine are rare and constitute less than 5% of bony tumours accounting for 2.5-8.5 affected individuals per 100,000 people per year. Primary spinal tumours can be divided into benign and malignant. Metastatic disease of the spine is much more common with 40-80% of patients who die of cancer having bony metastases at the time of their death and the spine being one of the most common sites of metastasis. A further subdivision in both benign and malignant disease is anatomical - that of bony and intradural components, though the focus in the current review is on the bony involvement. A key presenting feature is pain, with characteristic features which will be discussed in detail. Meticulous clinical assessment and work-up with early recognition and diagnosis can significantly improve morbidity and be curative in benign disease. Despite advances in treatment, the overall prognosis in malignant spinal disease, either metastatic or primary is relatively poor. This chapter provides a broad overview of neoplastic conditions looking at presenting signs and symptoms, differentials, clinical assessment and principles of management. This should allow for prompt recognition and expedite treatment.