Anatomic Distribution of Metastases in the Vertebral Body and Modes of Hematogenous Spread

Study Design: A retrospective review of the magnetic resonance spine examinations of 49 patients with metastatic bone disease to the spine was performed.

Objectives: To determine whether the pattern of metastatic distribution in the spine correlates with the type of primary tumor and theoretical mode of hematogenous spread by arterial or venous routes.

Summary Of Background Data: In 1940, Batson theorized a venous plexus route by which tumors spread to the spine from pelvic tumors such as prostatic carcinoma. It this theory is true, the venous vascular anatomy of the spine would result in metastases being deposited in the central or posterior vertebral body, whereas arterial deposits would occur near the end-plates.

Methods: Each vertebral body was divided into 27 equal cells in the magnetic resonance images; the central and posterior cells in the midsagittal view were defined as central, and the other cells were defined as peripheral. The primary tumor was assigned to either the arterial or venous group based on Batson's proposed mode of spread. The average number of lesions per involved vertebral body in the central and peripheral regions was calculated.

Results: There was no statistically significant correlation between tumors with proposed arterial/venous routes of metastasis and central/peripheral location of metastatic deposits.

Conclusion: The mechanism by which tumors spread to the vertebral body may not be via a pure arterial or venous route. Other mechanisms such as tissue specificity, cascade system, and closed loop circulation system may be involved.