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

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 retro-spectively examined.Materials and Methods: Among 186 patients with symptomatic spinal metastases who visited our de-partment between January 1, 2011, and December 31, 2017, 64 without the pedicle sign and with avail-able computed tomography (CT) and magnetic resonance imaging (MRI) data in the first visit were en-rolled and their data were analyzed. One author evaluated radiographs for findings suggestive of spi-nal metastases, CT to assess bone destruction, and MRI to evaluate the extent of lesions. Clinical vari-ables were also examined and compared between patients with and without bone changes on radiogra-phy.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 metasta-ses. 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)