Vertebral Metastases

Epidemiology

Metastatic disease is the most common extradural malignant spine tumor in adults. The most common age at presentation is between 50 and 60 years, but may occur earlier. There is no gender predilection. In adults, the majority of the spinal metastases arise from multiple myeloma (77%); breast (61%), lung (55%), and prostate cancer (51%); and lymphoma (40%). Spinal metastases in children are most often caused by Ewing’s sarcoma and neuroblastoma followed by osteogenic sarcoma, rhabdomyosarcoma, and lymphoma. The site of metastatic disease is thoracic in approximately 68%, lumbar or sacral in 16%, and cervical in 15% of cases.

Clinical Features

The most frequent symptoms of cervical spinal metastatic disease are pain and progressive neurological deficits. The pain may be local or radicular. Metastatic lesions of C1 and C2 most frequently present with severe pain and only rarely with neurological involvement, probably due to the size of the spinal canal at these levels.