Identification of epidural neoplasm: radiography and bone scintigraphy in the symptomatic and asymptomatic spine

Cancer cells present in one part of the body can spread to the spinal cord and develop tumors which compress the spinal cord or nerve roots. These spinal metastases occur in five to 10 percent of the patients with metastatic cancer. A loss of body strength and control in the areas below the spinal tumor will develop if treatment is not effective. Treatment success depends on the severity of the deficit before treatment is instituted. However, only a small proportion of patients with signs and symptoms of spinal involvement, such as pain, will actually have a tumor. The advent of magnetic resonance imaging, the use of a magnetic field to visualize internal structures, is a noninvasive method for evaluating the spinal cord. It is difficult to justify using this and other expensive procedures, which expose patients to radioactive imaging materials, when only a few patients will benefit. In this study other methods of imaging bone tumors, bone scintigraphy and radiography (X-rays), were used to determine the risk for spinal disease. The records and imaging results of 43 patients were reviewed. Patients were either symptomatic (41 patients) or asymptomatic. In the symptomatic patient group, evidence of spinal disease was found in 86 percent of the patients with abnormal radiographs and eight percent with normal radiographs. Evidence of spinal disease was present in 69 percent of the patients with abnormal scintigrams and none with normal scintigrams. In the patients without symptoms, spinal disease was found in 43 percent of the patients with abnormal radiographs and three percent with the normal radiographs. Spinal disease was present in 14 percent of those with abnormal scintigrams and seven percent with normal scintigrams. Radiography was highly predictive of spinal disease and scintigraphy was less sensitive. Symptomatic patients with abnormal radiography results should have further evaluation with magnetic resonance imaging or computerized tomography. The management of asymptomatic patients with abnormal radiographs is less clear and requires further study. (Consumer Summary produced by Reliance Medical Information, Inc.)