Complications of spinal tumors

Key complications and risks

Multiple or solitary tumor involvement of the spinal column structures is often accompanied by severe pain syndrome. A key imaging finding is frequently epidural extension of the masses (epidural extension).

Main risks for the patient include:

• Development of multiple compression fractures.
• Occurrence of vertebral body collapse.
• Development of spinal instability.
• Appearance of neurological deficits resulting from direct spinal cord compression (spinal cord compression).

Plasmacytoma (Plasmacytoma)

Plasmacytoma exhibits specific features across various imaging modalities due to its growth characteristics. The tumor predominantly destroys and replaces cancellous bone (cancellous bone), while the cortical layer may be partially preserved or even undergo sclerosis. On computed tomography (CT), this pattern creates a characteristic «hollow vertebral body or pedicle» appearance (hollow vertebral body or pedicle).

Radiography

• In two-thirds of cases, an expansive lytic bone lesion is identified. It is characterized by thickened bone trabeculae and a multilocular appearance.
• In one-third of cases, the picture is less specific, presenting as a multilocular «soap bubble» lesion (soap bubble), which can be mistakenly confused with a hemangioma.

MRI semiotics

• On T1-weighted images (T1WI), the lesion shows low signal intensity, while on T2-weighted images (T2WI), it shows high signal intensity.
• With contrast enhancement on T1WI, homogeneous and intense enhancement is observed.
• «Mini-brain» appearance (mini brain appearance): a typical diagnostic sign visible on axial slices (both MRI and CT). It appears as curvilinear structures with low MR signal that partially run through the vertebral body, visually resembling cerebral gyri. This phenomenon arises from cortical bone thickening against the background of slow, expansive growth of the plasmacytoma.

A frequent complication of plasmacytoma is focal endplate fractures (focal endplate fractures). In differential diagnosis with metastatic disease, an important criterion is the involvement of the intervertebral disc and adjacent vertebrae, which is more characteristic of plasmacytoma.

Multiple Myeloma (Multiple Myeloma)

The typical imaging pattern of multiple myeloma is represented by diffuse lytic «punched-out» destructive lesions (punched-out lesions) localized in one or several vertebrae simultaneously. However, an atypical picture is also frequently encountered: the patient may lack specific findings, showing instead only diffuse osteoporosis of the vertebral bodies or multiple compression fractures of unclear origin. It is important to remember that even in late stages of the disease, up to 20% of radiographs and MRI scans may show no deviations from the norm.

Multislice CT (MSCT, MDCT) MSCT provides detailed information on bone tissue destruction and allows visualization of the entire spinal column. The method significantly surpasses standard radiography in evaluating anatomically complex areas such as the pelvis and thoracic spine. Furthermore, MSCT provides the most accurate information on bone biomechanical strength and the risk of vertebral fractures.

MRI diagnostics Magnetic resonance imaging is the method of choice for the qualitative assessment of diffuse bone marrow changes. Signal patterns can vary greatly: from a normal bone marrow picture to isolated focal lesions or total diffuse infiltration.

• T1WI: diffuse or focal low signal is characteristic.
• Contrast-enhanced T1WI: pronounced gadolinium enhancement is noted in the affected areas. The use of fat suppression mode is mandatory.
• T2WI: lesion conspicuity (lesion conspicuity) is significantly improved by using fat suppression or STIR pulse sequences (lesions show a pronounced high signal).

Focal lesions in multiple myeloma can clinically and radiologically mimic metastases due to pathological fractures, massive bone marrow replacement, and potential epidural extension. In modern practice, Whole body MRI (Whole body MRI) using standardized MY-RADS reporting criteria is increasingly used for precise diagnosis, staging, and dynamic monitoring of myeloma.

Class and exam questions

What else to study on this topic

• Imaging semiotics of spinal sarcomas (chondrosarcoma, osteosarcoma, Ewing sarcoma)
• Principles and criteria of the standardized MY-RADS reporting system
• Differential diagnosis of diffuse bone marrow changes on MRI
• Technique of Whole body MRI in oncopathology
• Mechanisms of formation of focal endplate fractures

Other topics in the "Spine" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.