Multilevel spinal lesions beyond metastases

To review multi-level spinal lesions where metastasis was a possible differential diagnosis.

A series of anonymised patients who presented with multilevel spinal lesions were reviewed. Some patients presented with contiguous, multilevel, or diffuse spinal changes which ultimately proved to not be metastases despite initial suspicion. All these spinal lesions were evaluated with extensive imaging. If imaging features were suspicious for metastases or showed aggressive features, biopsy was performed. All data was anonymised.

Despite not being metastases, some of these lesions can appear aggressive in nature. Differential diagnosis of multilevel spinal lesions included bone infarcts, Paget's, extra-medullary haematopoiesis, treatment related and axial spondyloarthropathy.

To help readers gain experience and confidence in assessing the differential diagnosis of multi-level spinal lesions which could be metastases.