Vertebral Hemangioma Symptomatic During Pregnancy Treated by Posterior Decompression, Intraoperative Vertebroplasty, and Segmental Fixation

Abstract

Hemangioma is one of the most common benign tumors of the spine, and it remains silent in the vast majority of the subjects afflicted. Pregnancy is a known risk factor for symptomatic conversion of the previously dormant vertebral hemangiomas. However, the occurrence is rare with only 24 cases reported in the literature. The authors present a case of vertebral hemangioma symptomatic during the third trimester of pregnancy. The patient, a 20-year-old woman in her 33rd week of pregnancy, initially presented with acute back and bilateral leg pain, and developed the cauda equina syndrome within a week of its onset. Imaging studies revealed an L2 vertebral hemangioma, and the thecal sac was severely compressed by the epidural portion of the tumor. Emergency decompression and reconstruction surgery was undertaken 3 days after an uneventful cesarean section. The combined surgical management, consisting of laminectomy, intraoperative vertebroplasty, and segmental fixation, afforded adequate decompression, instant mechanical stability of the spine, and prompt pain elimination. The long-term efficacy of this combined treatment is unclear and needs to be followed cautiously.

Undiagnosed vertebral hemangioma causing a lumbar compression fracture and epidural hematoma in a parturient undergoing vaginal delivery under epidural analgesia: a case report

“…The decision-making is probably more difficult for pregnancies of 32-36 weeks. 15 Chi et al recommend observation for females with stable condition and prepartum surgery only in cases with paraplegia due to severe spinal cord compression. If surgery is considered, the risks of preterm spontaneous delivery and intraoperative exposure to radiation should also be taken into account.…”

Symptomatic vertebral hemangiomas during pregnancy

“…13 Since that first publication, 27 new cases have been described (Table 1). 1,[3][4][5][6][7][8][9][10][11][13][14][15][16][18][19][20][21][22][23][24][25][26][27][28][29] The diagnosis was usually made during the third trimester (22 of 27 cases). The mean maternal age at the time of diagnosis was 30 years.…”

“…[6][7][8][9]11,[19][20][21]24,26,28,29 Only half of these cases were treated antepartum. 8,[19][20][21]28 Only 1 of the 8 cases of prematurity (between 32 and 36 weeks of gestation) 1,3,10,[13][14][15]19,23 was treated antepartum. 13 Finally, only 1 of the 7 cases close to term (beyond 36 weeks of gestation) 4,5,16,22,25,27 at the time of diagnosis was treated antepartum.…”

“…The postpartum surgical management performed by most authors is laminectomy (12 of 19 cases), 1,[3][4][5]7,9,10,14,22,26,27,29 without a complementary procedure in half of the cases. Neurological recovery was observed in all but 1 case in this group; 26 recovery was only partial after laminectomy and the patient was subsequently treated by embolization and corpectomy.…”

“…After multidisciplinary discussion, we decided to perform vertebroplasty to treat the hemangioma and to stabilize the vertebral body. Other authors have also performed first-line complementary procedures in combination with laminectomy, 1,4,5,9,10,14,16,21 comprising radiotherapy, vertebroplasty, or embolization with good results (Table 1). It is surprising that in this type of surgery associated with a high bleeding risk, embolization was performed prior to laminectomy in only 1 case, 5 although this procedure has been shown to reduce intraoperative bleeding.…”