Balloon kyphoplasty as a single or as an adjunct procedure for the management of symptomatic vertebral haemangiomas

Abstract

Vertebral haemangiomas are usually asymptomatic and discovered fortuitously during imaging. A small proportion may develop variable degrees of pain and neurological deficit. We prospectively studied six patients who underwent eight surgical procedures on 11 vertebral bodies. There were 11 balloon kyphoplasties, six lumbar and five thoracic. The mean follow-up was 22.3 months (12 to 36). The indications for operation were pain in four patients, severe back pain with Frankel grade C paraplegia from cord compression caused by soft-tissue extension from a thoracic vertebral haemangioma in one patient, and acute bleeding causing Frankel grade B paraplegia from an asymptomatic vascular haemangioma in one patient. In four patients the exhibited aggressive vascular features, and two showed lipomatous, non-aggressive, characteristics. One patient who underwent a unilateral balloon kyphoplasty developed a recurrence of symptoms from the non-treated side of the vertebral body which was managed by a further similar procedure. Balloon kyphoplasty was carried out successfully and safely in all patients; four became asymptomatic and two showed considerable improvement. Neurological recovery occurred in all cases but bleeding was greater than normal. To avoid recurrence, complete obliteration of the lesion with bone cement is indicated. For acute bleeding balloon kyphoplasty should be combined with emergency decompressive laminectomy. For intraspinal extension with serious neurological deficit, a combination of balloon kyphoplasty with intralesional alcohol injection is effective.

Vertebral hemangioma coincident with metastasis of colon adenocarcinoma

“…8,14,15 Compression is secondary to extradural extension of the VH or cortical bulging; rarely is it caused by hemorrhage in the vertebral canal or vertebral fracture. 1,6,8,9,15 There are reports on the rapid onset of signs of VH in the third trimester of pregnancy, suggesting that growth of the hemangioma can be stimulated by elevated secretion of estrogen with contribution of increased intraabdominal pressure. 3,8,9,15,16 To the best of our knowledge, spontaneous malignant transformation of VHs has not been reported.…”

“…1,6,8,9,15 There are reports on the rapid onset of signs of VH in the third trimester of pregnancy, suggesting that growth of the hemangioma can be stimulated by elevated secretion of estrogen with contribution of increased intraabdominal pressure. 3,8,9,15,16 To the best of our knowledge, spontaneous malignant transformation of VHs has not been reported. 2,3,8 According to criteria highlighted by Laredo and colleagues, aggressive VHs most frequently affect vertebrae from T-3 to T-9 and involve the entire VB, pedicles, and vertebral arch.…”

Percutaneous vertebroplasty in symptomatic hemangioma versus osteoporotic compression fracture

“…In the past, symptomatic VHs were usually treated by radiotherapy, selective arterial embolization, or surgical excision and stabilization. Nonetheless, all of these treatment modalities have documented hazardous complications16 and currently most specialists prefer to treat these lesions by PVP preceded with or without intralesional ethanol injection 1718…”

Clinical and imaging findings in patients with aggressive spinal hemangioma requiring surgical treatment

“…3 Most VHs are asymptomatic and are diagnosed incidentally during investigations for other spinal problems, 3 but infrequently patients with VH can present with pain or symptoms of neurological compression. 2,[5][6][7][8][9][10][11][12] VHs can be classified as asymptomatic, symptomatic or compressive based on their behavior and their radiologic appearance on plain radiography, CT and MRI. 4,13 The imaging characteristics of VHs are reliable indicators of the aggressiveness of the lesion.…”