Vertebral or femoral bone lesions at risk of collapse

Observation. A single vertebral body lesion without soft tissue extension to the extradural space may be observed only.[103]

Low-dose radiation therapy. Low-dose radiation therapy may be used to promote resolution in an isolated vertebral body lesion or a large femoral neck lesion at risk of fracture, where chemotherapy is not usually indicated (single bone lesion). Despite the low dose required (7–10 Gy), radiation therapy should be used with caution because of concerns about secondary malignancies in adjacent tissues, skeletal deformities if the growth plates are irradiated in very young children,[96,101] or if the thyroid gland would be in the radiation field in cervical vertebral lesions.

Chemotherapy. Patients with soft tissue extension from vertebral lesions are often treated successfully with chemotherapy,[46][Level of evidence C2] but prolonged therapy does not appear to be needed beyond the period required to reduce the mass and any risk to the spinal cord. The risk of reactivation of a single bone lesion was only 9% in one large retrospective series.[104]

Bracing or spinal fusion. When instability of the cervical vertebrae and/or neurological symptoms are present, bracing—or rarely, spinal fusion—may be needed.[105]