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The thoracic spine is most commonly involved. The extradural lesions account for up to 95% of spinal lesions and can be divided into pure epidural lesions and those originating from the vertebra extending to the epidural space and subsequently impinging on the thecal sac. Together, these account for more than 80% of primary tumors in patients presenting with metastases.

Common tumors with a high rate of metastasis to bone include tumors of the breast (72%), prostate (84%), thyroid (50%), lung (31%), kidney (37%), and pancreas (33%). The frequency with which spine metastases are detected varies considerably with the type of primary tumor. Fortunately, only 10% of these patients are symptomatic. Approximately 60–70% of patients with systemic cancer will have spinal metastasis. The spine is the third most common site for metastatic disease, following the lung and the liver and the most common osseous site. Metastases to the spine can involve the bone, epidural space, leptomeninges, and spinal cord. Imaging plays a fundamental role in not only diagnosis but also treatment planning of spinal metastatic disease. Physiologic properties, particularly in treated disease, can be evaluated with other imaging modalities such as FDG PET and advanced MRI sequences. CT best delineates osseous integrity, while MRI is better at assessing soft tissue involvement. Imaging modalities have complimentary roles in the evaluation of spinal metastatic disease. Awareness of the different manifestations of spinal metastatic disease is essential as the spine is the most common site of osseous metastatic disease. This is a review of the imaging techniques and typical imaging appearances of spinal metastatic disease. The spine is the third most common site for metastatic disease, following the lung and the liver.