Primary sources for spinal metastatic disease include the following: Lung (31%), Breast (24%), GI (9%), Prostate (8%), Lymphoma (6%), Melanoma (4%), Unknown (2%), Kidney (1%), Others including multiple myeloma (13%). Time relation between primary and spinal metastases vary according to the site and nature of the primary. Spread from primary tumors is mainly by the arterial route via nutrient artery. Retrograde spread through the Batson plexus during Valsalva maneuver has been postulated. Direct invasion through the intervertebral foramina also can occur.
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