[Primary bone tumors of the spine]

Primary bone tumors of the spine are rare causes of spinal symptoms and often present with nonspecific clinical findings. Reliable differentiation from degenerative or inflammatory conditions is usually only possible by imaging. Precise anatomical compartment allocation as well as the combination of magnetic resonance imaging (MRI) and computed tomography (CT) are essential for diagnosis.

The aim of this review is to provide an overview of primary benign and malignant bone tumors of the spine, focusing on their imaging characteristics and differential diagnostic features.

A narrative review of typical spinal bone tumors, considering clinical presentation, pathophysiology, and radiologic findings. Benign lesions included osteoma, osteoid osteoma, osteoblastoma, osteochondroma, vertebral hemangioma, and aneurysmal bone cyst, while malignant entities comprised chondrosarcoma and chordoma.

Benign tumors demonstrate characteristic imaging patterns: osteomas appear as homogeneous sclerotic lesions without relevant contrast enhancement, whereas osteoid osteomas typically present with a small vascularized nidus and surrounding sclerosis. Osteoblastomas are usually larger and expansile-destructive. Osteochondromas show continuity of the cortex and medullary cavity with the host bone. Vertebral hemangiomas demonstrate characteristic trabecular patterns, while aneurysmal bone cysts typically show fluid-fluid levels on MRI. Malignant tumors such as chondrosarcomas present as osteolytic lesions with chondroid matrix calcifications, whereas chordomas appear as locally destructive tumors with marked T2 hyperintensity and soft-tissue extension.

Imaging plays a central role in the diagnosis and differential diagnosis of primary spinal bone tumors. MRI is particularly important for assessing tumor extent and soft-tissue involvement, whereas CT enables detailed evaluation of matrix mineralization and cortical destruction. Despite characteristic imaging features, overlap between benign and malignant lesions exists, making interdisciplinary radiologic-pathologic correlation frequently necessary.