Hemangiomas of the Spine and Their Surgery

V.E. Parfenov, B.A. Manukovsky, I.Sh. Karabaev, D.V. Kandyba, M.N. Kravtsov

(Faculty of Neurosurgery, Medicomilitary Academy, Saint Petersburg)

A vertebral column is a place, where bone hemangiomas are usually localized. According to literature data, they account for 4-29% of all primary tumors of the spine.

A problem of etiology and pathomorphology of hemangiomas, their place in classifications of developmental defects of vessels or vascular tumors proper has not been solved up to now.

Vertebral hemangiomas are described as greatly vascularized pathologic formations with atrophy of adjacent bone tissue and a long-term asymptomatic course. Usually they are reveled incidentally during MRI or CT examinations. The analysis of existing data has demonstrated, that hemangiomas can manifest themselves as aggressively as real tumors do. In such a case there appear an epidural and paravertebral soft-tissue tumorous component, resorption of an adjacent bone, quick growth and compression of the spinal cord.

Today the most effective method of treatment of vertebral hemangiomas is puncture vertebroplasty. Injection of bone cement into a body of a vertebra, affected by hemangioma, promotes quick regression of pain syndrome and gives an antineoplastic effect.

Numerous retro- and prospective studies are indicative of positive results of puncture vertebroplasty in this pathology.

Transcutaneous vertebroplasty has been used in the Clinic of Neurosurgery for several years. We have mastered methods of bone cement injection into cervical, thoracic and lumbar spine. Operations are performed in single- and multilevel lesions with simultaneous administration of cement into bodies of 4-5 and more vertebrae.