1
|
Kato K, Teferi N, Challa M, Eschbacher K, Yamaguchi S. Vertebral hemangiomas: a review on diagnosis and management. J Orthop Surg Res 2024; 19:310. [PMID: 38789994 PMCID: PMC11127296 DOI: 10.1186/s13018-024-04799-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Vertebral hemangiomas (VHs) are the most common benign tumors of the spinal column and are often encountered incidentally during routine spinal imaging. METHODS A retrospective review of the inpatient and outpatient hospital records at our institution was performed for the diagnosis of VHs from January 2005 to September 2023. Search filters included "vertebral hemangioma," "back pain," "weakness," "radiculopathy," and "focal neurological deficits." Radiographic evaluation of these patients included plain X-rays, CT, and MRI. Following confirmation of a diagnosis of VH, these images were used to generate the figures used in this manuscript. Moreover, an extensive literature search was conducted using PubMed for the literature review portion of the manuscript. RESULT VHs are benign vascular proliferations that cause remodeling of bony trabeculae in the vertebral body of the spinal column. Horizontal trabeculae deteriorate leading to thickening of vertical trabeculae which causes a striated appearance on sagittal magnetic resonance imaging (MRI) and computed tomography (CT), "Corduroy sign," and a punctuated appearance on axial imaging, "Polka dot sign." These findings are seen in "typical vertebral hemangiomas" due to a low vascular-to-fat ratio of the lesion. Contrarily, atypical vertebral hemangiomas may or may not demonstrate the "Corduroy" or "Polka-dot" signs due to lower amounts of fat and a higher vascular component. Atypical vertebral hemangiomas often mimic other neoplastic pathologies, making diagnosis challenging. Although most VHs are asymptomatic, aggressive vertebral hemangiomas can present with neurologic sequelae such as myelopathy and radiculopathy due to nerve root and/or spinal cord compression. Asymptomatic vertebral hemangiomas do not require therapy, and there are many treatment options for vertebral hemangiomas causing pain, radiculopathy, and/or myelopathy. Surgery (corpectomy, laminectomy), percutaneous techniques (vertebroplasty, sclerotherapy, embolization), and radiotherapy can be used in combination or isolation as appropriate. Specific treatment options depend on the lesion's size/location and the extent of neural element compression. There is no consensus on the optimal treatment plan for symptomatic vertebral hemangioma patients, although management algorithms have been proposed. CONCLUSION While typical vertebral hemangioma diagnosis is relatively straightforward, the differential diagnosis is broad for atypical and aggressive lesions. There is an ongoing debate as to the best approach for managing symptomatic cases, however, surgical resection is often considered first line treatment for patients with neurologic deficit.
Collapse
Affiliation(s)
- Kyle Kato
- University of Iowa Carver, College of Medicine, Iowa City, IA, USA.
| | - Nahom Teferi
- Department of Neurosurgery, University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| | - Meron Challa
- University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| | - Kathryn Eschbacher
- Department of Pathology, University of Iowa Carver, College of Medicine,, Iowa City, IA, USA
| | - Satoshi Yamaguchi
- Department of Neurosurgery, University of Iowa Carver, College of Medicine, Iowa City, IA, USA
| |
Collapse
|
2
|
Sharma R, Goyal S, Laythalling RK. Adjunct role of liquid absolute alcohol intralesional sclerotherapy during the surgical management of spinal primary aneurysmal bone cyst in a child: a technical case report. Childs Nerv Syst 2024; 40:569-573. [PMID: 37778002 DOI: 10.1007/s00381-023-06149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Aneurysmal bone cyst is composed of variable -sized cystic blood-filled spaces separated by connective tissue septae. First-line surgical resection of spinal aneurysmal bone cyst in a child with limited total blood volume can lead to massive intraoperative bleeding, thus limiting extent of resection. Our Centre's has good experience of using absolute alcohol as an effective immediate devascularizing agent during vertebral hemangioma surgery in children. MATERIAL AND METHODS We report the first case of pediatric lumbar primary aneurysmal bone cyst in which completely blood-less piecemeal total resection of the lesion was performed after intraoperative absolute alcohol intralesional sclerotherapy. RESULTS Completely blood-less piecemeal total resection of the lumbar aneurysmal bone cyst was performed after intraoperative absolute alcohol intralesional sclerotherapy. CONCLUSION Intraoperative absolute alcohol intralesional sclerotherapy is a very effective devascularizing adjunct for complete piecemeal resection of spinal aneurysmal bone cyst in children with limited blood volume.
Collapse
Affiliation(s)
- Rajeev Sharma
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India.
| | - Sarvesh Goyal
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India
| | | |
Collapse
|
3
|
Tonosu J, Yamaguchi Y, Higashikawa A, Watanabe K. Ethanol Sclerosis Therapy for Aggressive Vertebral Hemangioma of the Spine: A Narrative Review. J Clin Med 2023; 12:3926. [PMID: 37373622 DOI: 10.3390/jcm12123926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Vertebral hemangiomas of the spine are rare benign tumors. They occur primarily in the thoracic region and are often asymptomatic and found incidentally on radiological examination; however, some are symptomatic, aggressive, and gradually increase in size. Various therapeutic approaches have been proposed for their management. This study aimed to review the therapeutic management, focusing on ethanol sclerosis therapy. The PubMed database was searched from inception to January 2023 using the keywords "hemangioma", "spine OR vertebra", and "ethanol". Twenty studies were retrieved, including two letters. The first report of spinal therapy was published in 1994. Ethanol sclerosis therapy is effective in treating vertebral hemangiomas. It is performed independently or in combination with other techniques, such as vertebroplasty using cement and surgery. The therapy is performed under local or general anesthesia with fluoroscopic or computed tomography guidance. A total of 10-15 mL of ethanol is slowly injected via unilateral or bilateral pedicles. Complications of the therapy include hypotension and arrhythmia during the procedure, paralysis immediately after the procedure, and delayed compression fractures. This review could enable the refinement of knowledge regarding ethanol sclerosis therapy, which is a treatment option that could be adopted.
Collapse
Affiliation(s)
- Juichi Tonosu
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
| | - Yasuteru Yamaguchi
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
| | - Akiro Higashikawa
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
| | - Kenichi Watanabe
- Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki 211-8510, Kanagawa, Japan
| |
Collapse
|
4
|
Sekar A, Datta D, Parameshwar, Gulla KM, Bansal S. Aggressive vertebral hemangiomas in children. Childs Nerv Syst 2023; 39:571-575. [PMID: 36416953 DOI: 10.1007/s00381-022-05760-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aggressive vertebral hemangiomas are rare tumors in children, usually occurring in the thoracic spine that can cause significant neurological morbidity. They are technically difficult to treat with significant risk of blood loss during surgery. METHODS We describe a case of aggressive vertebral hemangioma managed in our institution. We performed a literature review of reported cases of aggressive vertebral hemangiomas in pediatric age group. We discuss the clinical presentation, diagnosis, and management of these lesions. RESULTS We identified 23 cases of aggressive vertebral reported in children. Neurodeficit was the most common presentation, and the most common location was the thoracic spine. Surgery was the most common modality of treatment. All the patients reported in literature had improvement in their symptoms after treatment. CONCLUSION Although technically challenging, aggressive vertebral hemangiomas have a good outcome after treatment. Treatment should be tailored to the individual patient. Further studies are needed to determine the optimum treatment strategy.
Collapse
Affiliation(s)
- Arunkumar Sekar
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India.
| | - Debajyoti Datta
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Parameshwar
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Krishna Mohan Gulla
- Department of Pediatrics, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| | - Sumit Bansal
- Department of Neurosurgery, All India Institute of Medical Sciences - Bhubaneswar, Bhubaneswar, Odisha, 751019, India
| |
Collapse
|
5
|
De Marco R, Piatelli G, Rossi A, Nasto LA, Pavanello M. Stepwise approach for vertebral hemangioma in children: case-reports and treatment algorithm proposal. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:3748-3758. [PMID: 35608706 DOI: 10.1007/s00586-022-07241-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/03/2022] [Accepted: 04/20/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To discuss a treatment algorithm for vertebral hemangioma in children. METHODS Vertebral hemangioma (VH) is a rare cause of low back pain in children. In most cases, VHs present as incidental findings and do not require invasive diagnostic procedure. In case of symptomatic presentation, different approaches can be used. Over the years, we have developed a treatment algorithm for VH in children based on our clinical experience. In this manuscript, we propose a stepwise approach to treatment of VHs based on tumor extension and the degree of spinal cord/nerves compression with or without neurological deficit. RESULTS According to the proposed protocol, we discuss two cases of aggressive VH treated at our institution by a multidisciplinary team. The first case is about a young girl treated with percutaneous one-level posterior instrumentation followed by medical adjuvant therapy for an L4 "Stage 3" VH. The second case is about an 8-year-old boy with rapidly progressive myelopathy due to T11 "Stage 4" VH treated with a combined anterior and posterior surgery (i.e., posterior decompression and fusion followed by vertebrectomy and expandable cage placement) after preoperative arterial embolization. CONCLUSION Given the lack of international guidelines and consensus with regard to treatment of VHs in children, we believe our proposal for a stepwise approach combining clinical and radiological characteristics of the lesion may help guide treatment of this condition in children.
Collapse
Affiliation(s)
- Raffaele De Marco
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy.
- Neurosurgery Unit, Department of Neuroscience, "Rita Levi Montalcini", "Città Della Salute e Della Scienza" University Hospital, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Gianluca Piatelli
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| | - Andrea Rossi
- Interventional Radiology and Neuroradiology Unit, IRCSS Istituto "G. Gaslini", via G.Gaslini 5, 16148, Genoa, Italy
| | - Luigi Aurelio Nasto
- Department of Paediatric Orthopaedics, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| | - Marco Pavanello
- Department of Neurosurgery, IRCCS Istituto "G. Gaslini", via G. Gaslini 5, 16148, Genoa, Italy
| |
Collapse
|
6
|
Singh PK, Verma SK, Chandra PS, Sawarkar D, Doddamani R, Agrawal M, Kumar A, Meena R, Agrawal D, Garg A, Kale SS. Management of Myelopathy due to Anterior Soft-Tissue Compression in Vertebral Hemangioma. World Neurosurg 2021; 155:e1-e8. [PMID: 34153483 DOI: 10.1016/j.wneu.2021.06.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/10/2021] [Accepted: 06/11/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Vertebral hemangiomas are benign but highly vascular lesions and are one of the most common lesions of the vertebral column. Anterior soft-tissue compression of spinal cord due to vertebral body hemangioma is challenging to manage. Our objective was to assess long-term clinical and radiologic effects of direct transpedicular absolute alcohol embolization, laminectomy, and short-segment instrumented fusion on resolution of extraosseous epidural soft tissue and improvement in myelopathy in cases of vertebral hemangioma causing anterior soft-tissue compression. MATERIALS AND METHODS This was a retrospective analysis that included patients with single-level vertebral hemangioma with anterior intraspinal soft-tissue growth causing spinal cord compression and clinical features of myelopathy between June 2007 and June 2019 at authors' institute. Transpedicular vertebral body injection of absolute alcohol, laminectomy, and pedicle screw rod instrumentation was performed in all patients. Clinicoradiologic outcomes of surgery were noted. We proposed a grading system for the extent of anterior extraosseous epidural soft-tissue compression. RESULTS In total, 14 patients were included in study. Their mean age was 28.4 ± 14.4 years. Mean follow-up duration was 67.5 ± 36.2 months. All patients had preoperative radiologic grade 4 compression. Postoperative radiologic grading improved to grade 1 in 4 (28.6%), grade 2 in 8 (57.1%), and grade 3 in 2 (14.3%). All the patients improved neurologically after surgery. Eleven patients improved to American Spinal Injury Association (ASIA) grade E, 2 improved to ASIA D, and 1 improved to ASIA C at the last follow-up visit. CONCLUSIONS Vertebral hemangiomas with anterior extraosseous epidural extension causing spinal canal compromise and myelopathy can be managed with direct transpedicular ethanol embolization, laminectomy, and short-segment instrumented fusion with resolution of the extraosseous soft tissue and improvement in myelopathy. The procedure is relatively simple, cost effective, and has a good outcome.
Collapse
Affiliation(s)
- Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Kumar Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Poodipedi S Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Dattaraj Sawarkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Meena
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
7
|
Brunette-Clément T, Weil AG, Shedid D. Total en bloc spondylectomy of locally aggressive vertebral hemangioma in a pediatric patient. Childs Nerv Syst 2021; 37:2115-2120. [PMID: 33130918 DOI: 10.1007/s00381-020-04954-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Vertebral hemangiomas are benign, highly vascular spinal lesions that are extremely rare in the pediatric population. We report a pediatric case of symptomatic vertebral hemangioma treated with total en bloc spondylectomy. Our objective is to demonstrate that en bloc spondylectomy is feasible and addresses some pitfalls of traditional total tumor resection. METHODS Our patient presented with bilateral lower limb and perineal paresthesia, paraparesis, as well as urinary retention. Locally aggressive vertebral hemangioma was the presumed diagnosis following imaging. The patient received partial angioembolization to reduce the vascularization of the lesion then underwent total en bloc spondylectomy of T8 under intraoperative neuromonitoring. The intervention was well tolerated. RESULTS Postoperative course was marked by clinical improvement and only transient, treatable complications. On 1-year follow-up, the patient is neurologically intact, and imaging reveals adequate position of hardware, good alignment, and no tumor recurrence. CONCLUSION Total en bloc spondylectomy is a feasible procedure in pediatric patients. It reduces local recurrence through reduction of tumor cell contamination and residual tumor and thus may avoid postoperative radiotherapy in select cases. It may also enhance functional neurological recovery by allowing circumferential decompression and increased spinal cord blood flow.
Collapse
Affiliation(s)
- Tristan Brunette-Clément
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Alexander G Weil
- Division of Neurosurgery, Sainte-Justine University Hospital Center, 3175, chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.
| | - Daniel Shedid
- Division of Neurosurgery, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| |
Collapse
|
8
|
Singh PK, Chandra SP, Agrawal M, Sawarkar D, Kumar R, Kumar A, Verma S, Kale SS. Long-Term Outcome of Surgical Management in Symptomatic Pediatric Vertebral Hemangiomas Presenting With Myelopathy. Neurosurgery 2020; 87:1240-1251. [PMID: 32629465 DOI: 10.1093/neuros/nyaa273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 04/15/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Vertebral hemangiomas are benign, highly vascular lesions of the vertebra, rarely seen in the pediatric age group. OBJECTIVE To analyze the long-term (>3 yr) outcome of patients of pediatric vertebral hemangioma presenting with myelopathy and to describe our surgical strategy to treat such cases. METHODS All patients up to 18 yr of age with a symptomatic vertebral hemangioma treated at our hospital from May 2003 to August 2016, with at least 3-yr follow-up were included. Functional clinical outcomes were measured using American Spinal Injury Association (ASIA) score. RESULTS There were 7 male and 7 female patients. All hemangiomas were located in the thoracic spine with single-level involvement. Upper thoracic spine involvement was more common (12 cases: 85.71%) than lower thoracic spine involvement (2 cases: 14.29%). All patients had features of myelopathy. The mean age was 14.57 yr, ranging from 10 to 18 yr. The mean follow-up was 62.21 mo, ranging from 36 to 90 mo. All patients had improvement in motor strength of both lower limbs postoperatively. Local pain, which was present in 1 patient, resolved, and the bladder symptoms present in 5 patients also resolved. CONCLUSION Our experience in treating symptomatic pediatric vertebral hemangiomas, along with the long-term follow-up data, suggests that good postoperative results can be achieved with minimal complications in carefully selected patients.
Collapse
Affiliation(s)
- Pankaj K Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Mohit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Dattaraj Sawarkar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajender Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank S Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
9
|
Surgical Management and Adjuvant Therapy for Patients With Neurological Deficits From Vertebral Hemangiomas: A Meta-Analysis. Spine (Phila Pa 1976) 2020; 45:E99-E110. [PMID: 31365517 DOI: 10.1097/brs.0000000000003181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVE To understand the benefits and limitations of surgical management and adjuvant therapies for patients presenting with neurological deficits from vertebral hemangiomas (VH). SUMMARY OF BACKGROUND DATA VH is the most common benign spine tumor but rarely causes symptoms. Patients with back pain alone are treated with conservative management (kyphoplasty and radiation therapy), while those with neurological deficits require complex multi-modal treatment plans. METHODS A PubMed literature search for "symptomatic vertebral hemangioma with spinal cord compression" identified 47 articles. From these articles and their references, 19 observational studies on patients who underwent surgery for VH met inclusion criteria. Meta-analyses were performed comparing outcomes of the surgical and adjuvant therapies using Stata13 software. For those with insufficient data for meta-analyses, descriptive analyses of variables were completed. RESULTS One hundred ninety seven surgical cases of VH with neurologic deficits were identified. Surgery provided a complete remission of symptoms in 84% of patients, however 18% of patients had recurrence of hemangioma. Adjuvant interventions included radiation, embolization, and kyphoplasty. Radiation therapy (XRT) was associated with a lower recurrence rate and an increase in minor transient adverse effects. Preoperative embolization performed in 98 patients was associated with improved symptoms, reduced complications, lower recurrence rate, less blood loss, and higher incidence of pathologic vertebral fractures. Meta-analyses did not yield statistically significant results, likely due to the heterogeneity amongst the studies and small sample sizes, but the results compiled together provide insight on potential benefits of preoperative embolization for symptomatic relief and reduced risk of recurrence with XRT that deserves further study. CONCLUSION For patients with neurologic deficits from spinal cord or nerve root compression, surgery provides improvement in symptoms. Recurrence of VH and symptoms refractory to surgery can be further reduced by adjuvant therapies such as embolization, kyphoplasty, and radiation with some unique risks to each therapy. LEVEL OF EVIDENCE 2.
Collapse
|
10
|
An ethical dilemma: how to treat a symptomatic pediatric vertebral hemangioma? CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
11
|
Long-term outcome of treatment of vertebral body hemangiomas with direct ethanol injection and short-segment stabilization. Spine J 2019; 19:131-143. [PMID: 29890263 DOI: 10.1016/j.spinee.2018.05.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/13/2018] [Accepted: 05/16/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vertebral body hemangiomas with myelopathy are difficult to manage. OBJECTIVE The objective of this study was to evaluate the role of intraoperative ethanol embolization, surgical decompression, and instrumented short-segment fusion in vertebral hemangioma (VH) with myelopathy and long-term outcome (>24 months). CLINICAL MATERIALS AND METHODS This prospective study included symptomatic VH with cord compression with myelopathy. Pathologic fractures and deformity or multilevel pathologies were excluded from the study. Surgery consisted of intraoperative bilateral pedicular absolute alcohol (<1% hydrated ethyl alcohol) injection, laminectomy, and cord decompression at the level of pathology followed by a short-segment instrumented fusion using pedicle screws. RESULTS The study included 33 patients (mean 26.9±13.2, range: 10-68 years, 18 females). The clinical features of the study were myelopathy in all patients (5 paraplegic), sphincter involvement (13), and mid back or lower back pain (7). The preoperative American Spinal Injury Association (ASIA) scores were A (7), B (11), C (6), D (8), and E (1). Majority of the patients had single vertebral involvement (30) and three patients had multiple-level involvement. Six patients underwent surgery earlier (one underwent alcohol embolization). The mean surgical time was 124±39 minutes, and the average blood loss was 274±80 cc. The mean amount of absolute alcohol injected was 14.6±5.7 cc (two patients required 20 and 25 cc). Immediate embolization was achieved in all patients, allowing laminectomy and easy removal of soft-tissue hemangioma. Post surgery, one patient had transient deterioration, and the condition of the rest of the patients improved (sphincters improved in nine patients) at a follow-up ranging 28-103 months (mean 47.6±22.3). Follow-up ASIA scores were E (26), D (4), B (2), and C (1). All patients showed evidence of bone sclerosis and relief of cord compression on follow-up imaging. CONCLUSIONS This is the largest study in literature showing excellent improvement, low reoperation rates after ethanol embolization, and short-segment fixation.
Collapse
|
12
|
Persad AR, Fox RJ, Rempel JL. Symptomatic Vertebral Hemangioma of the Posterior Elements Sharing Blood Supply with a Radiculomedullary Artery. Int J Spine Surg 2018; 12:415-418. [PMID: 30276100 DOI: 10.14444/5049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Vertebral hemangiomas are common lesions usually restricted to the vertebral body. They are characterized by proliferation of endothelial cells and subsequent expansion of vascular spaces within the bone. These lesions are usually clinically silent and are discovered incidentally. Only rarely are vertebral hemangiomas symptomatic. Here, we present the case of a 68-year-old female with an aggressive hemangioma causing neurologic deficit. The lesion was localized within the posterior spinal elements, with no involvement of the vertebral body. Transarterial embolization was deemed unsafe due to the close proximity of a prominent radiculomedullary artery. The patient was treated with posterior decompression at T4-T6.
Collapse
Affiliation(s)
- Amit R Persad
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Richard J Fox
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeremy L Rempel
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|