What are osteosarcoma spinal tumors?

Updated: Nov 01, 2018
  • Author: Andrew A Sama, MD; Chief Editor: Jeffrey A Goldstein, MD  more...
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Osteosarcomas of the spine are rare, making up only 0.6-3.2% of all osteosarcomas and only 5% of all primary malignant tumors of the spine. They typically present in patients in the fourth decade of life and have a male predominance. Osteosarcomas are found at all levels of the spine but are most common in the lumbosacral segments. Eccentric involvement of the vertebral body with extension into the posterior elements is common.

Patients often present with pain and a palpable mass. Neurologic symptoms, ranging from sensory deficits to paresis, are found in 70-80% of patients. Serum alkaline phosphatase may be elevated.

Plain radiographs of spinal osteosarcomas reveal a densely mineralized matrix, giving rise to the term ivory vertebrae. A loss of vertebral height often occurs, with sparing of the adjacent disc. Purely lytic lesions also have been described. CT and MRI are useful for evaluating the extent of bony and soft-tissue involvement. If a large amount of mineralized matrix is present, the lesion may appear with low signal intensity on all MRI sequences.

Most osteosarcomas are blastic lesions (osteoblastic, chondroblastic, or fibroblastic). Osteosarcomas can arise primarily or secondarily from an exposure to radiation. Secondary osteosarcomas can have a latency of up to 20 years. Spinal osteosarcomas also have been found in patients with Paget disease.

Surgical resection is the rule; however, resection of spine lesions is often incomplete due to the size and location of the tumor at the time of presentation. Adjuvant chemotherapy and radiation therapy often are employed with varying degrees of utility. Spinal osteosarcomas have a dismal prognosis, with deaths usually occurring within the first year of diagnosis. Only a few patients have been reported to survive longer than 2 years.

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