Spinal Osteosarcoma

Spinal involvement of osteosarcoma is rare, accounting for 3–5% of all osteosarcomas. The most frequent symptom of spinal osteosarcoma is pain, whereas neurologic deficit is frequent, indicating a locally advanced disease at presentation. The diagnosis is made by histology. MRI is the imaging modality of choice for local staging. Chest CT and bone scintigraphy is the classic combination for distant staging. Whole-body MRI, 18-FDG-PET/CT, and 18-FDG-PET/MRI are interesting alternatives. Treatment is based on en bloc tumor removal, chemotherapy, and radiotherapy, although curative surgery is technically difficult due to anatomical particularities of the spine. Overall prognosis remains poor.