Acute spinal cord compression caused by vertebral hemangioma.

BACKGROUND CONTEXT: The reported incidence of vertebral hemangioma within the spinal column is common. Most often these benign vascular tumors are incidental radiographic findings and do not cause neurological sequelae. Rarely, vertebral hemangiomas will cause compressive neurological symptoms, such as radiculopathy, myelopathy and paralysis. In these cases the clinical presentation is usually the subacute or delayed onset of progressive neurological symptoms. This report demonstrates a symptomatic vertebral hemangioma presenting with rapid onset neurologic sequelae.

PURPOSE: To discuss diagnostic and management issues presented by symptomatic vertebral hemangioma.

STUDY

DESIGN

Case report and review of literature.

PATIENT SAMPLE: Sixty-one-year-old white woman with low back pain and rapidly progressive myelopathic symptoms.

METHODS

A case of vertebral hemangioma with neurological sequelae is presented followed by a discussion of the literature concerning diagnostic and therapeutic options in the management of this pathologic entity.

RESULTS

The results of our review reveal that the incidence of vertebral hemangioma causing compressive neurological symptoms is rare despite the overall prevalence of vertebral hemangioma. Vertebral hemangioma may present with rapid onset myelopathic symptoms and may mimic those symptoms caused by a malignancy. Radiographic imaging modalities are extremely useful and display characteristic findings in the diagnostic evaluation of these tumors. Angiographic embolization of feeding vessels has been effective in minimizing operative blood loss, and surgical decompression and stabilization is frequently indicated. Postsurgical radiotherapy has also been demonstrated to serve as a limited adjunct to surgery by reducing tumor recurrence in the event of less than complete tumor resection.

CONCLUSIONS

Because of the rapid presentation of myelopathic symptoms in this case, preoperative angiographic embolization was not performed, and the patient underwent emergent decompressive surgery. In this case emergent operative decompression and stabilization was effective in reversing the patient's myelopathic symptoms, while maintaining long-term stability of the spinal column. Postoperative radiation was not administered because of the extent of tumor resection. Surgical intervention has produced long-term cure of this patient's myelopathy and T10 vertebral hemangioma.