Diagnosis

The first symptom of bony metastasis is often back pain. In fact, pain is the most common presenting symptom for tumors involving the axial skeleton and spinal cord. The hallmark of neoplastic lesions of the axial skeleton is localized spinal pain, associated with recumbency and night pain. Pain in the axial skeleton occurs in up to 85% of patients in the larger series of vertebral column tumors and usually begins well prior to any radicular pain or neurological deficit. However, ultimate diagnosis relies on a combination of laboratory investigation, radiographic studies and, potentially, tumor biopsy.

Diagnostic imaging is a cornerstone in the diagnosis of metastatic lesions of the spine. Typically, patients with known carcinoma are staged using multiple modalities of imaging, although, frequently, the spinal axis is not routinely screened unless symptoms are present.

The initial work-up for all patients should include plain radiographs of the spine. Anterior-posterior and lateral X-rays of the region in question can often give important information in the diagnosis of malignancy and can typically be done in an expedited fashion, with little cost to the medical system or patient. Pathologic compression fractures, the presence of a blastic lesion or destructive process within the vertebral bodies, or the destruction of the pedicle on AP views are often characteristic of spinal metastasis. Further, important information on sagittal alignment, including the

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