gms | German Medical Science

Objective: Spinal Heamangiomas usually show a benign behavior, found to be 2 – 3% of all spine tumors. Within autopsy or using MRI, they can be found in up to 10 % of all spine tumors. These tumors consist of blood vessels, may result in excavation of the vertebral body and result in fractures or spinal cord compression. Preoperative embolization seems to be a useful tool to reduce blood loss under surgery and is - combination with irradiation or vertebroblasty and posterior fixation – a possible treatment. We saw, however, following this treatment, a relevant number of local recurrence (Figure 1 [Fig. 1]). Here, we present our experiences with recurrent hemangiomas as well as initially aggressive hemangiomas with extensive growth, narrowing the spinal canal causing neurological symptoms.

Methods: Data presented here are extracted from the register of a large spine center in Germany. Search paradigm was "hemangioma". Time of data acquisition: 1/ 1997-12/2017. We present demographic data, clinical symptoms, localization of the tumor, kind of surgery, which was performed first and the definitive operative treatment

Results: 24 Patients, mean age 55±17years, 1 FU 7 months – 19 years.14 F, 10 M. 75% of the patients with local pain, 25% with neurological symptoms. Main localization (62%) was the thoracic spine, the vertebral body was always affected and there was always an epidural invasion. 33% of patients had received a pretreatment, (3 with vertebroplasty, 5 with decompression of the spinal canal, followed by posterior instrumentation). Preoperative embolization was performed in 19 cases. In 83% final treatment was a vertebral – body -en-bloc resection and fixation (Figure 2 [Fig. 2]). Intracavitary spongiosaplasty and incomplete vertebral body resection in each 8% of patients. At the time no recurrence.

Conclusion: Although spinal hemangiomas usually grow within the vertebral body without spinal canal invasion, there are some with more aggressive behavior – both initially or seen as recurrence. In those cases the hemangiomas invade the spinal canal, resulting in severe neuro deficits. We suppose that simple decompression with instrumentation or vertebroplasty is not sufficient to prevent further growth in these cases. Thus, radical resection and an intense FU are necessary both in recurrence and in initially aggressive tumors, too. Moreover, a preoperative embolization to prevent intraoperative bleeding seems to make sense.