-Original-

Spinal Metastases without Pedicle Signs on Radiograph and their Associated Clinical and Radiological Features

Yasuyuki Kitagawa, Koichiro Ono, Ryu Tsunoda and Tokifumi Majima

Department of Orthopaedic Surgery, Nippon Medical School, Tokyo, Japan

Background: The pedicle sign is a radiographic indicator of spinal metastases. However, it is not only the pedicle sign that is important in radiographic diagnosis of bone metastases. In the present study, the radiological features of symptomatic spinal metastases in patients without the pedicle sign were retrospectively examined.
Materials and Methods: Among 186 patients with symptomatic spinal metastases who visited our department between January 1, 2011, and December 31, 2017, 64 without the pedicle sign and with available computed tomography (CT) and magnetic resonance imaging (MRI) data in the first visit were enrolled and their data were analyzed. One author evaluated radiographs for findings suggestive of spinal metastases, CT to assess bone destruction, and MRI to evaluate the extent of lesions. Clinical variables were also examined and compared between patients with and without bone changes on radiography.
Results: Bone changes strongly suggesting bone metastasis, other than the pedicle sign, were observed in 31 out of 64 patients: bone cortical disappearance in 20, increased radiolucency of the central area in the vertebral body in 8, an irregular osteoblastic change in 5, and asymmetrical vertebral collapse in 10. An analysis of CT data revealed that intertrabecular, mildly osteolytic, and mildly osteoblastic types were more frequent in patients without any changes suggestive of bone metastases on radiographs.
Conclusion: Radiographic findings other than the pedicle sign are useful for diagnosing bone metastases. The key to a radiographic diagnosis of spinal metastases is to pay attention to changes in the bone cortex of all vertebral components on radiographs in addition to the pedicle.

J Nippon Med Sch 2022; 89: 384-391

Keywords
pedicle sign, spinal metastasis, cortical destruction, intertrabecular, radiographic diagnosis

Correspondence to
Yasuyuki Kitagawa, MD, Department of Orthopaedic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
kitayasu@nms.ac.jp

Received, September 17, 2021
Accepted, December 15, 2021