What is a Spinal Hemangioma?

A spinal hemangioma is a tumor that mostly occurs in the thoracic and the lumbar spine. Also referred to as vertebral hemangioma, it is non-cancerous and has few symptoms. This is why most people do not realize that they have this condition unless an imaging test for another condition reveals its presence. The vertebral body is the most commonly affected by this tumor; however, it may also affect the muscles around the spine. Pain is the most common symptom and is reported by around 20% of the patients. Let’s have a brief look at the causes and treatments of spinal hemangioma pain.

Causes of Vertebral Hemangioma Pain:

The causes of spinal hemangioma are not much known, however, it is believed that there may be a genetic cause involved. Studies have also found that a high amount of estrogen present after birth may also increase the chances of this tumor. This is also considered to be a likely cause because the condition is more common in females than in men.

As mentioned above, there are rarely any symptoms when this tumor is present. In fact, the tumor is often found in 10-12% autopsies, which indicates that a person can actually go through life without even experiencing any symptom. However, some individuals may experience pain. A likely cause of this pain is a spinal hemangioma that is quite large and involves the entire vertebral body. There may also be a collapse and loss of height in the vertebrae if the tumor is extensive. A severe collapse means that the spinal cord and the nerves emanating from it will get compressed causing pain, numbness or weakness in the legs, and even loss of function in the bowel or bladder.

Hemangioma diagnosis

If a hemangioma is suspected, the doctor will order an x-ray to check for a specific pattern on the bone, called a trabecular pattern. Trabecular, or cancellous, bone is a lattice-shaped structure within the bone.

A CT scan may also show a polka dot appearance in the bone. If this appears, an MRI will be ordered to show whether the tumor has expanded into the spinal column or spinal canal, or encroached on the spinal cord. MRI can also show the extent of nerve damage in the spine and can assist in planning surgical treatment.

Hemangioma symptoms

Most hemangiomas are symptom-free, but symptoms may include:

• Back pain
• Pain that radiates along a nerve due to inflammation or irritation of the nerve root
• Spinal cord compression

Treatments:

It is also possible that the spinal hemangioma may extend beyond the vertebrae. This could be a cause of back pain in some individuals. Trauma may also occur and lead to a compression fracture of the vertebrae causing hemorrhage or bleeding. Extra pressure due to a pregnancy may put extra pressure on the vertebrae and cause or increase the back pain.

Once the tumor is discovered, these patients need to go for regular checkups to diagnose the presence of compression fractures, neurological dysfunction, or the development of a soft tissue mass. If pain and other symptoms are present due to a hemorrhage or another reason, the treatment will depend on the extent of the bleeding and the severity of the neurological symptoms. The size and location of the hemangioma will also determine the treatment administered.

Embolization is one of the treatment options available. In this procedure, a tiny catheter or tubing is inserted and a specific material, such as polyvinyl alcohol foam, is injected. This material travels to the bleeding site. As it builds up at the site of the hemorrhage, the flow of blood stops.

The most common treatment for these painful lesions is radiotherapy, in which high energy X-rays are used to kill the tumor cells. Studies have found that high doses administered to patients with pain associated with spinal hemangioma are quite successful in achieving complete pain relief.

Excision or surgical removal of the spinal hemangioma may be required if spinal cord compression is present causing pain, numbness, and weakness. In cases where, a partial removal of the tumor is performed, radiotherapy is required as an additional treatment. It is also the most common treatment for children since they are more prone to the harmful effects of radiation.Radiation therapy is effective in the treatment of pain caused by hemangiomas. Ethanol injections with fluoroscopic guidance have also proven effective in treating pain. Another treatment option is embolization followed by removal of the small bones that make up a vertebra (laminectomy) or removal of the vertebra (vertebrectomy).

The presence of spinal hemangioma pain and neurological symptoms are the likely reasons that treatment is required. If the symptoms are worsening rapidly, surgical procedures are recommended. However, if the symptoms develop slowly, radiotherapy or embolization are considered to be better options.