Spinal Hemangioma

Continuing Education Activity

• Definition: Spinal hemangiomas are the most common primary tumor of the spine.
• Origin: These lesions are of vascular origin, involving proliferation of capillary and venous structures.
• Incidence: Usually found incidentally on radiological imaging.
• Symptoms: 0.9% to 1.2% become symptomatic, causing back pain and neurologic issues.
• Objective:
  • Identify etiology and histopathology.
  • Evaluate and manage suspected cases.
  • Treatment options and role of interprofessional team.

Introduction

• Prevalence: Identified in about 11% of patients at autopsy.
• Imaging: Often found on CT, MR imaging, radiographs of thoracolumbar spine.
• Symptoms: Severe back pain, neurogenic pain if extending into spinal canal or foramina.

Etiology

• Characteristics: Vascular proliferation causing bone displacement or erosion.
• Comparison: Unlike infantile hemangiomas, spinal versions don’t regress spontaneously.

Epidemiology

• Incidence: 11% at autopsy; higher in females; MRI studies show up to 27%.

Histopathology

• Types:
  • Cavernous angiomas: Large blood vessels, no bone separation.
  • Capillary angiomas: Thin-walled capillary vessels, with bone separation.
• Presentation: Capsule surrounds lesion, with possible adjacent bone osteolysis.

History and Physical

• Goals: Rule out more serious causes and assess health status for intervention.
• Symptoms: Back pain, radiculopathy, thoracic spine presentation.
• Examination: Back inspection, spine curvature, gait, range of motion, percussion, reflex tests, and specific maneuvers.

Evaluation

• Imaging: Critical for assessing lesion size, site, and involvement.
  • Radiographs: Prominent trabecular pattern.
  • CT: Corduroy pattern from trabeculae coarsening.
  • MRI: Soft-tissue extension assessment.

Treatment / Management

• Approach: Usually non-intervention for asymptomatic.
• Interventions:
  • Endovascular embolization.
  • Percutaneous vertebroplasty.
  • Transpedicular ethanol injection (with caution).
  • Radiation therapy.

Differential Diagnosis

• Conditions to Consider:
  • Paget disease, sclerotic metastasis (e.g., prostate carcinoma), lymphoma, multiple myeloma.

Complications

• Potential Issues: Pathologic fracture, epidural extension, exiting nerve root issues, spontaneous hemorrhage.

Consultations

• Pain medicine, orthopedics, neurosurgery.

Deterrence and Patient Education

• Advice: Reassure patients with asymptomatic hemangiomas; monitor for pain or neurologic deficits.

Enhancing Healthcare Team Outcomes

• Approach: Coordinated care between primary care, radiologists, physiatrists, and surgeons.

Figures

• MRI T2 sequences and vertebral body hemangioma images provided by Dr. Dawood Tafti.

References

• Comprehensive list of studies and papers supporting the content.