BACKGROUND: Spinal tumors constitute 10-32% of all primary central nervous system tumors. Accurate radiologic and histopathology diagnosis is crucial in the management and prognosis. The aim of the study was to describe the imaging patterns and to determine the agreement of imaging pattern of spinal tumors with intra-operative and histopathology findings.METHODS: A retrospective cross-sectional study of 47 patients with spinal tumor done from May 2018 to October 2020. Medical records were reviewed for clinical data, history, physical examination, magnetic resonance imaging (MRI), intraoperative findings and histopathology reports. The agreement between imaging, intraoperative finding and histopathology diagnosis was analyzed.RESULTS: Intradural extramedullary tumors constituted 37 (78%) cases followed by six (12.8 %) extradural tumors and four (9.2%) intramedullary tumors. Schwannoma accounted for 13 (27.7%) cases followed by meningioma, 12 (25.5%) cases. Twenty-seven (57.4%) cases were thoracic level and cervical level were nine (19.1%) cases. Twelve (25.5%) cases did not have a definite intraoperative diagnosis. Imaging and intraoperative diagnosis was in agreement in 21 (44.6 %) cases and disagreed in 14 (29.7%) cases. For the imaging diagnosis and histopathology, 29 (61.7%) were in agreement and 18 (38.3 %) were in disagreement.CONCLUSION: In conclusion, the commonest site to be involved was the thoracic spine and schwannoma was the commonest tumor. The low agreement between imaging and histopathology could have been improved by optimizing the imaging reports and techniques.KEYWORDS: Agreement, CT, Histopathology, MRI, Spine tumors