Destructive lesions of the spine

1. neoplastic; see Differential diagnosis: spine & spinal cord tumors for more:

a) metastatic tumors with a predilection for bone:prostate,breast,renal cell,lymphoma,thy- roid, lung…; see Spinal epidural metastases.

b) primary bone tumors:chordomas,osteoid osteoma,hemangioma

2. infection:

a) vertebral osteomyelitis: occurs mostly in IV drug abusers,patients with diabetes mellitus, and hemodialysis patients. May have associated spinal epidural abscess. Also see Vertebral osteomyelitis

b) Discitis

3. chronic renal failure: some patients develop a destructive spondyloarthropathy that resembles infection11,12

4. ankylosing spondylitis: bamboo spine (square VBs with bridging syndesmophytes)

5. lesions producing posterior scalloping of VB (mnemonic: AMEN)

A acromegaly or achondroplasia

M Marfan syndrome or mucopolysaccharidosis

E Ehlers-Danlos

N neurofibromatosis

also: dural ectasia

6. lesions producing anterior scalloping of VB

a) aortic aneurysm

b) lymphoma

c) spinal TB