Approximately 10% of patients with systemic malignancies may develop intraspinal metastases, most commonly originating from primary cancers of the lung, prostate, breast, and kidney. The majority of spinal metastatic tumors are located in the extradural space, with the thoracic region being the most frequently affected, followed by the lumbar region. The primary routes of metastasis are through the vascular or lymphatic systems. Paraspinal tumors can invade the spinal canal via the intervertebral foramina, and direct metastasis to the vertebrae may also occur.
In 95% of cases, the initial symptoms are localized radicular pain or referred pain, which is typically severe. Back pain during recumbency is a characteristic manifestation of such tumors. Enhanced MRI is the primary diagnostic tool, while CT or X-ray imaging can help assess bone involvement.
The primary goals of treatment are to alleviate pain, maintain spinal stability, and preserve sphincter and ambulatory function. Radiotherapy can be used as a standalone treatment or as an adjuvant therapy after surgery. Depending on the nature of the primary tumor, chemotherapy may also be considered.