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Spinal metastasis (SMs) are the most encountered tumors of the spine. Their occurrence is expected roughly around one to two years after primary tumor diagnosis. Since the advent of Magnetic Resonance Imaging (MRI), this technology has been considered the gold standard for SMs diagnosis and characterization due to its precise ability to comprehend the rate of soft tissue compression/invasion (dural sac/nervous tissue), which is one of the main drivers of management strategies. Computed Tomography (CT) remains unbeatable when a detailed bony anatomy and instability assessment is searched. Nuclear medicine technologies may have a role in diagnosis when standard MR or CT study findings are inconclusive or when the extent of the systemic metastatic disease is studied. The main objective of this study is to offer an update on the epidemiology and radiology of spinal metastasis (SMs), endorsed by the WFNS Spine Committee. A systematic review of the literature of the last ten years gave 1531 results with "spine/spinal metastatic tumors/metastasis AND radiology OR imaging OR classification" as search strings in all fields, of which 56 papers were fully analyzed. The results were discussed and voted on in two consensus meetings of the WFNS (World Federation of Neurosurgical Societies) Spine Committee, reaching a positive or negative consensus using the Delphi method. The committee stated nine recommendations on two main topics: (1) Incidence and epidemiology of SMs; (2) Radiology and classifications of SMs., Competing Interests: Declarations Ethics approval Not applicable. Consent to participate Not applicable. Consent to publish Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Study Design: A retrospective case series., Objective: This study developed a novel classification system based on imaging and anatomy to select optimal surgical approaches and reconstruction strategies to achieve total resection of cervical dumbbell tumors and restore spinal stability., Summary of Background Data: Total resection is necessary to decrease the recurrence rate of cervical dumbbell tumors. Previous cervical dumbbell tumor classifications are insufficient for determining surgical strategies; therefore, a practical classification is needed., Materials and Methods: This study included 295 consecutive patients with cervical dumbbell tumors who underwent total surgical resection. A novel classification of cervical dumbbell tumors was developed based on magnetic resonance imaging and computed tomography. Continuous variables were expressed as mean±SD and were compared using an unpaired two-tailed Student t test. The χ 2 test or the Fisher exact test was used for categorical variables. Kendall's W test assessed three independent raters' inter-rater and intrarater reliabilities on 140 cervical dumbbell tumors., Results: The inter-rater and intrarater consistency coefficient was 0.969 (χ 2 =404.3, P <0.001) and 0.984 (χ 2 =273.7, P <0.001). All patients with type I and II tumors underwent single-posterior surgeries to achieve total resection. Of the patients in this study, 86.1%, 25.9%, 75.9%, and 76.9% underwent posterior surgeries for types IIIa, IIIb, IVa, and V tumors, respectively. All patients with type IVb tumors underwent a combined anterior and posterior approach. Posterior internal fixation was used for all patients in posterior surgery. Anterior reconstruction was applied for patients with type IVb tumors (20/20, 100%) and some with type V tumors (3/13, 23.1%). The mean follow-up duration was 93.6±2.6 months. A recurrence was observed in 19 (6.4%) patients., Conclusion: The authors describe a novel classification system that is of practical use for planning the complete resection of cervical dumbbell tumors., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Most patients with spinal tumors suffer no symptoms or have mild symptoms, but about 14% of patients have refractory pain caused by mechanical instability, or symptoms of spinal cord damage caused by epidural spinal cord compression. The Spinal Instability Neoplastic Score (SINS) and Kostuik classification are commonly used to evaluate spinal stability, and help to make a more detailed operation plan. The objectives of this study are to evaluate the reliability and reproducibility of the SINS and Kostuik classification, and to explore their clinical application value., Methods: All 80 patients with spinal tumors were enrolled. Six spine surgeons who have certain clinical experience were selected. Patients were scored according to the SINS scoring system and classification was determined according to the Kostuik system. We used Fleiss and Cohen κ values to check the coefficient consistency for multifactors. We used Cohen κ value to check the interobserver reliability and intraobserver reproducibility. After 12 weeks, we repeated the analysis., Results: The interobserver reliability and intraobserver reproducibility of the SINS scoring system were near perfect with values of 0.831 and 0.874, respectively. The interobserver reliability and intraobserver reproducibility of the Kostuik classification system were moderate with values of 0.505 and 0.595, respectively., Conclusions: Compared with the Kostuik classification system, the SINS scoring system has better interobserver reliability and intraobserver reproducibility, which can be widely used in clinical practice and has great significance in the decision-making of spinal tumor treatment. Although the Kostuik classification system is often used in clinical practice, it shows inferior reliability and reproducibility in our study., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose To evaluate the use of susceptibility-weighted MRI for the differentiation of predominantly osteoblastic and osteolytic spine metastases. Materials and Methods For this prospective study, 53 study participants (mean age, 54.5 years ± 14.3 [range, 22-88 years]; 27 men with a mean age of 55.3 years ± 12.7 [range, 22-72 years] and 26 women with a mean age of 53.8 years ± 15.7 [range, 23-88 years]) with clinically suspected spine metastases underwent imaging with standard MRI sequences, susceptibility-weighted MRI, and CT. Sensitivities and specificities of MRI sequences for the detection of predominantly osteoblastic and osteolytic metastases were determined by using CT as the reference standard. The metastases-to-vertebral body signal intensity ratio (MVR) was calculated to compare modalities. Phantom measurements were obtained to correlate bone densities between MRI sequences and CT. Results A total of 64 metastases (38 predominantly osteoblastic, 26 predominantly osteolytic) were detected. Susceptibility-weighted MRI achieved a sensitivity of 100% (38 of 38) and specificity of 96% (25 of 26) for predominantly osteoblastic metastases and a sensitivity of 96% (25 of 26) and specificity of 100% (38 of 38) for predominantly osteolytic metastases. Standard MRI sequences achieved a sensitivity of 89% (34 of 38) and specificity of 73% (19 of 26) for predominantly osteoblastic metastases and a sensitivity of 73% (19 of 26) and specificity of 92% (35 of 38) for predominantly osteolytic metastases. MVR measurements obtained with susceptibility-weighted MRI demonstrated a strong correlation with those obtained with CT (R 2 = 0.75), whereas those obtained with T1-weighted MRI, T2-weighted MRI, and turbo inversion-recovery magnitude MRI showed a weak to moderate correlation (R 2 = 0.00, R 2 = 0.35, and R 2 = 0.39, respectively). Susceptibility-weighted MRI showed a strong correlation with CT with regard to metastases size (R 2 = 0.91). In phantom measurements, susceptibility-weighted MRI enabled the reliable differentiation of different degrees of mineralization (R 2 = 0.92 compared with CT). Conclusion Susceptibility-weighted MRI enables the reliable differentiation between predominantly osteoblastic and osteolytic spine metastases with a higher accuracy than standard MRI sequences. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Schweitzer in this issue.

OBJECTIVE Osteoblastoma is a rare primary benign bone tumor with a predilection for the spinal column. Although of benign origin, osteoblastomas tend to behave more aggressively clinically than other benign tumors. Because of the low incidence of osteoblastomas, evidence-based treatment guidelines and high-quality research are lacking, which has resulted in inconsistent treatment. The goal of this study was to determine whether application of the Enneking classification in the management of spinal osteoblastomas influences local recurrence and survival time. METHODS A multicenter database of patients who underwent surgical intervention for spinal osteoblastoma was developed by the AOSpine Knowledge Forum Tumor. Patient data pertaining to demographics, diagnosis, treatment, cross-sectional survival, and local recurrence were collected. Patients in 2 cohorts, based on the Enneking classification of the tumor (Enneking appropriate [EA] and Enneking inappropriate [EI]), were analyzed. If the final pathology margin matched the Enneking-recommended surgical margin, the tumor was classified as EA; if not, it was classified as EI. RESULTS A total of 102 patients diagnosed with a spinal osteoblastoma were identified between November 1991 and June 2012. Twenty-nine patients were omitted from the analysis because of short follow-up time, incomplete survival data, or invalid staging, which left 73 patients for the final analysis. Thirteen (18%) patients suffered a local recurrence, and 6 (8%) patients died during the study period. Local recurrence was strongly associated with mortality (relative risk 9.2; p = 0.008). When adjusted for Enneking appropriateness, this result was not altered significantly. No significant differences were found between the EA and EI groups in regard to local recurrence and mortality. CONCLUSIONS In this evaluation of the largest multicenter cohort of spinal osteoblastomas, local recurrence was found to be strongly associated with mortality. Application of the Enneking classification as a treatment guide for preventing local recurrence was not validated.

Study Design: One hundred twenty-four patients with spinal dumbbell tumors were analyzed retrospectively using a new classification., Objective: To recommend a novel classification of spinal dumbbell tumors based on the characteristics of surgical approach., Summary of Background Data: Current classifications of cervical dumbbell tumor are excessively convoluted with an impractical number of variables or lack of quantitative indicators for the choice of surgical approach, and there are few classifications described in the literature which related to thoracic or lumbar dumbbell tumors. An ideal classification must be simple and reproducible based on commonly identified clinical and radiographic parameters., Methods: The clinical records of a series of 124 patients with spinal dumbbell tumors were analyzed retrospectively using a new classification. We divided the largest transverse section of the tumor into four areas, and different areas need different surgical procedures., Result: Ninety-two patients were treated using the posterior approach alone, 13 patients underwent surgery by lateral cervical approach, and 19 cases were excised using combined anterior and posterior approach. Tumors total removal was 123 cases, with partial resection in one patient. Concomitant spinal fixation and fusion was performed in 18 patients. A total of 97 cases had follow-up with clinical and radiographic outcome variables ranged from 12 to 52 months (mean, 46.3 months). Eighty-eight patients (90.7%) had clinical improvement, whereas clinical status was the same in seven (7.2%), two patients (2.1%) demonstrated neurologic deterioration, and magnetic resonance imaging at last follow-up revealed no recurrence in any patient., Conclusion: The new classification of spinal dumbbell tumors is a simple way of identifying patients who require a different surgical approach., Level of Evidence: 4.

Benign tumors of the spine are rare and may lead to unspecific back pain. The classification of the lesion is typically achieved with a combination of imaging techniques (MRI and CT scans) and, in some cases, a histological sampling to allow differentiation from malignant processes. Both open and interventional (CT guided) biopsies are possible, depending on the localization of the tumor. Treatment strategies are diverse, require an interdisciplinary approach, and include operative and interventional procedures. The following article gives an overview of the most important benign tumors of the spine, the typical features in imaging, and treatment strategies.

Background: Malignant tumours particularly often metastasise to the spine, causing considerable pain and limiting the patient's physical function. Standard therapy consists in surgical treatment with adjuvant radiotherapy. The qualification for surgery is a multifaceted process and detailed analysis of the morphology of the metastasis is a key factor. Numerous types of classification of metastatic lesions exist, among which the Tomita system, based on MRI findings, appears to be the most practical. The aim of this paper is to present the current incidence of different morphological types of metastases as classified by the Tomita system., Materials and Methods: This work was based on cases treated at the Department of Oncological Orthopaedics of the Specialist Hospital in Brzozów - Podkarpacie Oncological Centre from 2010-2015. A total of 854 patients with spinal metastases were hospitalised at the department. All patients underwent a CT and MRI of the spine and their metastatic lesions were classified as one of the 7 types described by Tomita. The incidence of different morphological types of metastases per type of the primary tumour was also determined., Results: Most patients treated at the department had advanced disease as a result of diagnostic delays. Types T3-T7 were found in 91% of the patients and T7 in 44%. The highest incidence of advanced disease was seen among patients with breast cancer and myeloma. Higher pain severity and incidence of neurological complications were noted in patients with multisite lesions. Neurological deficits were diagnosed in 228 patients, of whom 68% were classified as Type T6 or T7. Most of the T6/T7 patients were unable to walk unassisted and required constant help from their family or medical staff., Conclusions: The Tomita system allows for easy and clear classification of the morphology of malignant metastases. 66% of patients treated at our department had multisite T6 or T7 metastases.

Dumbbell tumors can not only cause the compression of cervical cord and nerve root, but also invade the important structures and the surrounding organs, causing great harm to the patient. Toyama classification that is commonly used has not been evaluated and still requires independent validation.The objectives of this study were to evaluate and analyze the interobserver reliability and intraobserver reproducibility of Toyama classification system, explore the differences, discover the shortages, and evaluate the clinical value for diagnosis.One hundred sixty-five consecutive patients of a cervical dumbbell tumor with complete clinical and radiologic data were enrolled. Six surgeons determined the classification according to Toyama system. The classification was repeated 12 weeks later. Correlation coefficient (ICC) and kappa coefficient (κ) test were used to determine interobserver reliability and intraobserver reproducibility.The interobserver reliability for Toyama classification was moderate with a value of 0.432. The interobserver reproducibility for Toyama classification was moderate with a value of 0.608.The Toyama classification has landmark value in clinical practice, but it is a relatively cumbersome system. This study shows that it has low reliability and reproducibility. Accordingly, surgical management of the resection of dumbbell cervical tumors raises several problems, including preservation of the cervical nerve root, control of the vertebral artery, and maintenance of spine. There is a need to optimize the classification in the future.

Aim: To characterise and evaluate magnetic resonance imaging (MRI) images for their clinical value in diagnosing and assessing intraspinal mature teratoma., Materials and Methods: MRI images obtained from eight patients with a histopathologically verified intraspinal mature teratoma were analysed retrospectively regarding tumour location, size, and margins. Additionally, the signal intensity and enhancement pattern on MRI and other associated malformations were also assessed., Results: Three cases that contained fatty tissue showed markedly heterogeneous hyperintense signalling on T1-weighted images, and mixed hyperintense and hypointense signalling on T2-weighted images and fat-suppression sequences. All three of those cases showed an irregular peripheral fatty tissue signal, and one case showed additional patches of an interspersed calcification signal. The remaining five cases without fatty tissue displayed heterogeneous hyperintense signalling on T1-weighted images and T2-weighted images, and also on fat-suppression sequences. Four of the five cases showed additional patches of interspersed nodular calcification signals. Contrast-enhanced MRI images showed only slight enhancement (n=3)., Conclusions: MRI is regarded as the reference standard diagnostic technique to reveal the location of teratomas and the degree of spinal cord involvement. In most cases, MRI provides accurate anatomical and histological information, which is necessary for patients with suspected intraspinal mature teratoma., (Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Background Context: Spinal instability is an acknowledged complication of spinal metastases; in spite of recent suggested criteria, it is not clearly defined in the literature., Purpose: This study aimed to assess intra and interobserver agreement when using the Spine Instability Neoplastic Score (SINS) by all physicians involved in its management., Study Design: Independent multicenter reliability study for the recently created SINS, undertaken with a panel of medical oncologists, neurosurgeons, radiologists, orthopedic surgeons, and radiation oncologists, was carried out., Patient Sample: Ninety patients with biopsy-proven spinal metastases and magnetic resonance imaging, reviewed at the multidisciplinary tumor board of our institution, were included., Outcome Measures: Intraclass correlation coefficient (ICC) was used for SINS score agreement. Fleiss kappa statistic was used to assess agreement on the location of the most affected vertebral level; agreement on the SINS category ("stable," "potentially stable," or "unstable"); and overall agreement with the classification established by tumor board., Methods: Clinical data and imaging were provided to 83 specialists in 44 hospitals across 14 Spanish regions. No assessment criteria were pre-established. Each clinician assessed the SINS score twice, with a minimum 6-week interval. Clinicians were blinded to assessments made by other specialists and to their own previous assessment. Subgroup analyses were performed by clinicians' specialty, experience (≤7, 8-13, ≥14 years), and hospital category (four levels according to size and complexity). This study was supported by Kovacs Foundation., Results: Intra and interobserver agreement on the location of the most affected levels was "almost perfect" (κ>0.94). Intra-observer agreement on the SINS score was "excellent" (ICC=0.77), whereas interobserver agreement was "moderate" (ICC=0.55). Intra-observer agreement in SINS category was "substantial" (k=0.61), whereas interobserver agreement was "moderate" (k=0.42). Overall agreement with the tumor board classification was "substantial" (κ=0.61). Results were similar across specialties, years of experience, and hospital category., Conclusions: Agreement on the assessment of metastatic spine instability is moderate. The SINS can help improve communication among clinicians in oncology care., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Vascular anomalies included hemangiomas and vascular malformations (VMs). VMs are mediated by mutations in the endothelial cell-specific receptor tyrosine kinase Tie2 (TEK),which is essential for angiogenesis and vascular stabilization. We identified five types of Tie2 mutations in 80 patients with soft tissue or spinal VMs by PCR including the previously detected missense mutations 2690A>G (Y897C), 2740C>T (L914F), 2743C>T (R915C), and two nonsense mutations 2763G>A, 2688C>T, we identified Tie2 mutation in primary spinal VMs for the first time. Tie2 mutations were found to be absent in 33 patients with hemangiomas and DNA samples of VMs. In addition, we showed that Tie2 mRNA expression in spinal VMs was similar to soft tissue VMs, but obviously lower than infant hemangiomas (P<0.01). This study provides new insights into spinal VMs, the association of Tie2 and vascular anomalies needs to be further discussed., (Copyright © 2015. Published by Elsevier B.V.)