Background:Spine tumors remain a hot topic because of their associated morbidity by affecting motor and sensory function. Contrary to metastatic spine disease (MSD), extremely prevalent, rise within or surrounding the spinal cord and/or vertebral column, primary spinal tumors are rare, 5% of all primary skeletal tumors and frequently benign (20%). The diagnostic delay of these tumors, even when benign, is associated with a poor prognosis. Establishing the correct diagnosis is heavily reliant on magnetic resonance imaging and histological confirmation.Objectives:to provide an overview of the epidemiology, radiological and histopathological of spinal tumors diagnosed in a rheumatology department.Methods:A retrospective study consisting of clinical characteristics analysis, laboratory and x-ray examinations, was performed on 40 patients who were hospitalised for a spinal tumor, in a rheumatology department, over 5-year period from 2015 to 2020.Results:A total of 40 patients with a mean age of 66 ± 13.5 years [18-93] and a sex-ratio of 1.1, were included. The most common initial complaints were inflammatory back pain (67.5%) and fatigue (52.5%), with a median duration of 5 months. Physical examination abnormalities included lumbar stiffness (32.5%), radicular signs (18.7%), hepatomegaly (12.5%), and lymphadenopathy (17.5%). Neurological deficit was found in only 3 patients (7.5%). Hypercalcemia (corrected serum calcium > 105 mg/l), and anemia (hemoglobin (Hb) < 100 g/l in female, Hb <110g/l in male) were present initially in respectively 47.5% and 46.3% patients, while biological inflammatory syndrome was present in 89.7% patients (median C-reactive protein of 44.7). Tumor markers were performed in 12 patients and they were positive in 9 of them.Plain radiographs findings were vertebral compression fractures (43.6%), osteolytic lesions (30.8%) and osteoblastic lesions (12.5%). Lumbar spine was the most affected (57.5%), followed by the dorsal spine (45%). Magnetic resonance imaging (MRI) was performed in 55%, and the most common lesion was low signal intensity on T1-weighted sequences and high signal intensity on T2-weighted sequences (68.1%).In our study, only one patient was diagnosed for a myxopapillary ependymoma, a benign primary spinal tumor characterised by a metastatic dissemination risk. For the rest (39 patients), the diagnosis of bone metastasis, multiple myeloma (57.7%), and of solid tumor cancers (40%), were established. Primary cancers were mainly prostate cancer (37.5%), lung cancer (18.7%) and kidney cancer (18.7%). By a median follow-up time of 25 months, overall survival rate was 30%.Conclusion:Extradural lesions are the most common, and are typically metastatic. Special attention should be pain to the patient’s medical history and laboratory abnormalities. In fact, an early diagnosis requires a high index of clinical suspicion.Disclosure of Interests:None declared
Role of magnetic resonance imaging in the differential diagnosis of spinal signal changes caused by infection and tumor in the early stages