Unveiling Primary Bone Tumors of the Spine: A Review of Essential Imaging Clues

Primary spinal osseous tumors are relatively rare, comprising ~5–10% of spinal bone neoplasms, whereas metastases account for the vast majority of spinal lesions. Patients typically present with insidious back pain, sometimes with a focal mass, and constitutional symptoms are uncommon early in the disease course. As clinical features are often nonspecific and overlap with degenerative, infectious, and metastatic disease, imaging is essential for lesion identification, characterization, and treatment planning. Computed tomography helps to define osseous architecture and matrix characteristics, whereas magnetic resonance imaging can assess marrow involvement, soft-tissue extension, neural compression, and tumor vascularity. Advanced imaging can further refine the need for additional workup, optimize biopsy planning, inform prognostic assessment and ther-apeutic decision-making, and anticipate mechanical instability or neural compromise. This narrative pictorial review synthesizes radiographic, CT, and MRI appearances of primary spinal tumors across major histologic lineages (e.g., osteogenic, chondrogenic, notochordal, vascular), illustrated with representative cases. We correlate imaging with clinical presentation to distinguish typical from atypical variants and highlight mimics and interpretive pitfalls with implications for diagnostic interpretation and management.