Lysis of a vertebral segment

The analysis of lytic bone lesions on the vertebrae requires the accurate analysis of the various osseous limits, including the vertebral body, the pedicles, the apophyses as well as study of the bone structure.

In the case of vertebral collapse, it is necessary to precisely study the characteristics of this collapse in order to differentiate benign lesions (such as osteoporosis) from malignant invasion of the bone (primary or metastatic lesion). Any elderly patient may suffer from osteoporosis and irradiating a painful osteoporotic collapsed vertebra would be a disaster.

Benign vertebral collapses

Benign collapse can be unique or multiple.

It generally occurs after physical effort.

It is characteristic because the limits of the vertebral body are well conserved as well as the nearby pedicles (vertebrae 'eyes').

The other adjacent bones are also generally undermineralized with possible multiple collapses.

The posterior wall of the vertebral body is preserved with no neurological symptoms.

Malignant vertebral collapses

Malignant vertebral collapse is characterised by the irregularity of the vertebral limits, the hetoregeneity of the bone structure and the presence of multiple, non-systematic lesions.

Very often, lysis of one pedicle is observed (3rd and 6th one-eyed vertebrae, but not involving the same eye!).

Since the posterior wall may be concerned, clinical symptoms of medullary compression may be found (Babinski sign, paraparesis or paraplegia).

However, this distinction is far from being so simple: occasionally, close surveillance of disease evolution is necessary to confirm or infirm the malignant nature of a vertebral collapse.