What does vertebral hemangioma mean?

This is the 4000th article of Da Yi Xiao Hu

In the outpatient clinic, we often see some patients who come to the clinic for back pain (including chest and back pain or waist and back pain). After examination, it is found that it is mainly caused by back muscle strain, but the imaging report suggests: vertebral hemangioma. The patient is very nervous: Hemangioma? What does it mean? Is it malignant? It is benign now, will it become malignant in the future? Will it metastasize? Will it cause paralysis? Although after some explanation, the patient is still full of doubts.

What is a vertebral hemangioma?

Vertebral hemangioma is a relatively common benign vertebral tumor that can occur at any age, but is more common in the 40-50 age group. It is more common in women than in men. It is more common in the lower thoracic and upper lumbar spines, followed by the cervical and sacral spines. Most cases are single, and a few are multiple. Pathological manifestations include a large number of proliferating capillaries and dilated sinuses.

Why do hemangiomas occur?

This is also a question that many patients often ask. So far, the cause of vertebral hemangioma is unclear.

What are the clinical manifestations?

Although vertebral hemangioma has a high incidence in imaging, most of them have no clinical symptoms. According to literature reports, it can reach 27%, and only 1% of patients have clinical symptoms, and most of them are discovered accidentally during examinations; only a small number of patients suffer from back pain, spinal stiffness, and limited mobility due to the expansive growth of the tumor in the vertebral body and the destruction of the surrounding bones. If the protrusion of the spinal canal compresses the spinal cord, cauda equina, or nerve roots, it will cause corresponding symptoms.

How is it diagnosed?

Vertebral hemangioma is usually diagnosed by CT and MRI.

CT scans show typical palisade and grid-like changes, reduced trabeculae, and MRI shows high signals on T1W1 and T2W2 images. It is not difficult to make a clear diagnosis.

How to treat it?

First, it is necessary to clarify whether the clinical symptoms are related to vertebral hemangioma. If the hemangioma occupies a small proportion of the vertebral body, there are no clinical symptoms or the current clinical symptoms are unrelated to it, observation can be carried out.

If the vertebral hemangioma causes corresponding clinical symptoms, further treatment is required. In particular, if the hemangioma occupies a large proportion of the vertebral body, treatment should be carried out more actively to prevent the vertebral hemangioma from destroying the stability of the entire vertebral body and causing compression fractures.

At present, the most commonly used method for clinical treatment of vertebral hemangioma is percutaneous vertebroplasty, which can not only reduce or even relieve local pain, but also effectively prevent pathological fractures after vertebral reinforcement with bone cement. In addition, the toxicity of bone cement itself and the high temperature generated by the polymerization reaction after injection can effectively kill cells and prevent the recurrence of hemangioma.

In short, if you accidentally find a vertebral hemangioma during an examination, don't panic. It is a benign tumor. If there are no symptoms, no treatment is required, and only follow-up observation is required. For symptomatic hemangiomas, percutaneous vertebroplasty can be used with good results.

Department of Orthopedics, Tianjin Third Central Hospital

Guo ShuzhangChief Physician