Incidence, epidemiology, classification and radiology of primary vertebral tumors: WFNS spine committee recommendations

Abstract

Objective

This review is prepared to formulate the most current, evidence-based recommendations regarding the incidence, epidemiology, classification and radiological features of primary vertebral tumors.

Materials and methods

A systematic literature search in PubMed, MEDLINE, and CENTRAL was performed from 2013 to 2023 using the search terms “primary vertebral tumors”, “incidence”, “epidemiology”, “classification,” and “radiological diagnosis”. Screening criteria resulted in 6, 5, and 34 studies respectively that were analyzed regarding incidence, epidemiology, clinical diagnosis, and radiographic diagnosis of primary vertebral tumors. Using the Delphi method and two rounds of voting at two separate international meetings, ten members of the WFNS (World Federation of Neurosurgical Societies) Spine Committee generated nine final consensus statements.

Results

Primary tumors of the vertebral column are relatively rare, with an overall prevalence of 2.5 to 8.5 cases per 100,000 persons per year. In adults, hemangioma is the most common benign tumor of the spine, other common benign tumors in adults include osteoblastomas and osteochondromas. The most common malignant primary spinal neoplasm in adults is plasmocytoma (30 %) and other malignant tumors in adults include chondrosarcoma and osteosarcoma. Chordoma represents about 2–4 % of all spinal column tumors, 40 % of primary spinal tumors and has a high propensity for the sacral and cervical regions. Incidence of primary malignant vertrebral tumors is correlated with patient’s age. The risk increased significantly when patients were older than 40 years. CT and MRI are both required for proper diagnosis, with correlation of findings to age and clinical presentation. Biopsy can identify tumors and accurately determine the type, grade, and stage of tumors. Complication rates for percutaneous biopsy range between 1 and 3 %, compared to 16 % for open biopsy. Lower accuracy rates have also been reported in fibrotic, collagenous, and inflammatory lesions, as well as for specific lesions such as aneurysmal bone cysts and hemangiomas. Osteolytic or mixed lesions have a reported diagnostic yield of up to 88 %, compared with sclerotic lesions at 67 %.

Conclusions

Final nine consensus statements provide current, evidence-based guidelines on the incidence, epidemiology, classification and radiographic diagnosis of primary vertebral tumors for practicing spine surgeons worldwide.