Article
Aggressive giant hemangioma of the lumbar spine – a case report
Riesiges, aggressiv wachsendes lumbales Wirbelkörperhämangiom – ein Fallbericht
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Authors
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Gordian Schmid
- Donau-Ries-Klinik Donauwörth, Orthopädie, Unfallchirurgie und Wirbelsäulentherapie, Donauwörth, Deutschland
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Haiko Pape
- Donau-Ries-Klinik Donauwörth, Orthopädie, Unfallchirurgie und Wirbelsäulentherapie, Donauwörth, Deutschland
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Andreas Reinke
- Donau-Ries-Klinik Donauwörth, Orthopädie, Unfallchirurgie und Wirbelsäulentherapie, Donauwörth, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Vertebral hemangiomas are common lesions, which are seen as incidental findings, and are usually benign. Rare cases of aggressive hemangiomas are reported with compression fractures and neurological deficits. We present a highly unusual case of a 54-year old man with paraparesis and an infiltrative tumor in the lumbar spine
Methods: A 54-year-old male presented an acute sciatic pain and a paraparesis of his legs. Magnetic resonance imaging (MRI) revealed a massive tumor mass of the entire vertebral body of L3 and the surrounding tissue (diameter 65 mm) with subtotal compression of the spinal canal. Angiographic computed tomography (CT) showed a hypervascular bony lesion with loss of height of L3. Tumor staging could not prove any other neoplasia. We performed a dorsal stabilization with carbon instrumentation and decompression as an emergency procedure. After initial improvement of the symptoms a re-paraparesis of the legs appeared after a few days. The postoperative MRI demonstrated a recurrent increase of the tumor with compression of the spinal canal. After endovascular embolization a vertebral body replacement of L3 with anterior tumor resection was performed.
Results: Patient recovered completely from his neurological deficit after the second operation. Final pathologic diagnosis after surgery confirmed the diagnosis of an osseous hemangioma.
Conclusion: This case highlights an extremely unusual appearance of a giant and aggressive vertebral hemangioma with consecutive fracture. In addition, it shows the importance of preoperative MRI and vascular imaging as well as the necessary urgent surgical management.
