Basics

Enneking Staging System

Benign Lesions

Latent lesion
1. (HOOG) Hemangioma, Osteoid Osteoma, Osteochondroma, Granuloma Eosinophilic
2. Observation
3. Mx: intralesional excision +/- adjuvants (liquid nitrogen, phenol, PMMA)
Active lesion
1. (HOOOGA) Osteoid osteoma, osteochrondroma, hemangioma, eosinophilic granuloma, ABC
2. Mx: en bloc resection vs intralesional excision +/- adjuvants (liquid nitrogen, phenol, PMMA)
Aggressive lesion
1. GCT, osteoblastoma
2. Mc: wide excision (cuff of normal tissue)

Malignant Lesions

DDx Categories

Age, Location, Size

Age

Young 10-30

Middle 30-50

Older 50+

Location

Bone (Vertebrae)

Non-Bone (Spinal Cord)

Intradural Extramedullary
- Schwannoma
- Meningioma
Intradural Intramedullary
- Ependymoma
- Astrocytoma
  - Usually benign
- Intramedullary mets -> <3mo life expectancy
Extradural
- Metastasis
  - Extramedullary
    - Drop mets via CSF
  - Intramedullary
- Lymphoma
  - T2 hyperintense with marked homogenous contrast
  - Treatment: methotrexate

Scenarios and Responses

No current Ca Hx (includes people with no current Ca but +ve remote Ca Hx), Painful spine lesion in <40 – refer to ortho onc; likely biopsy
No current Ca Hx (includes people with no current Ca but +ve remote Ca Hx), Painful spine lesion in >40 – do mets staging workup because probably mets, but need to confirm
Current Ca Hx no fracture, Mirel Score <9 staging workup, bisphosphonates or denosumab to reduce risk of fracture
Current Ca with Impending Fracture – curretage with cement, fix hip to femur, post op rads
Path Fracture – Staging workup – core needle

Mirel Score – fix if >9