Spinal hemangiomas are benign (non-cancerous) growths of blood vessels that typically form within the bones of the spine, known as vertebrae. While often discovered incidentally and rarely causing symptoms, understanding when these growths might pose a risk is important.
Understanding Spinal Hemangiomas
A spinal hemangioma is a non-cancerous overgrowth of blood vessels within the vertebral body. These vascular malformations are the most common benign tumor of the spine. Spinal hemangiomas are often asymptomatic, causing no noticeable issues for most individuals, and are frequently discovered incidentally during imaging for other conditions.
Spinal hemangiomas are common, affecting an estimated 10% to 11% of the population. They are most frequently found in the thoracic (mid-back) and lumbar (lower back) regions of the spine. While they can occur at any age, they are most common after age 50, and females are more likely to develop them than males.
Signs They May Be Problematic
When a spinal hemangioma causes problems, it is typically due to its growth, leading to compression of the spinal cord or nerves. This can result in localized back pain, which may radiate into the arms or legs.
Compression of the spinal cord or nerves can also manifest as neurological symptoms such as numbness, tingling, or weakness in the limbs. Severe compression can lead to issues like difficulty walking or problems with bowel and bladder control. The hemangioma can also weaken the vertebral bone, leading to collapse or fracture and significant pain. Bleeding from the hemangioma can also occur, forming a hematoma that may compress nerves or the spinal cord.
How Spinal Hemangiomas Are Identified
Spinal hemangiomas are frequently identified incidentally during imaging studies of the spine for other health concerns. When symptoms arise, healthcare providers use imaging techniques for diagnosis and assessment. Magnetic Resonance Imaging (MRI) is often employed to determine the hemangioma’s extent and its effect on the spinal cord or nerves.
Computed Tomography (CT) scans can also be used, sometimes revealing a characteristic “polka-dot” or “corduroy” pattern within the bone. X-rays may show a honeycomb or lattice-like structure within the affected vertebra. These imaging methods allow accurate diagnosis and evaluation of potential complications.
Managing Problematic Spinal Hemangiomas
Treatment for spinal hemangiomas is generally only pursued if they are causing symptoms or complications. For asymptomatic cases, observation is the typical approach, often involving regular follow-up imaging. If the hemangioma causes pain or neurological issues, several interventions are available.
Vertebroplasty or kyphoplasty are minimally invasive procedures where surgical cement is injected into the affected vertebra to stabilize it, reduce pain, and prevent further damage. Radiation therapy can be used to shrink the hemangioma by damaging its abnormal blood vessels, which helps alleviate pressure on surrounding structures and reduce pain. In severe cases where there is significant compression of the spinal cord or nerves, surgical removal of part or all of the affected vertebra (vertebrectomy or laminectomy) may be considered. Other treatments, such as embolization to cut off blood supply to the tumor or ethanol injections, may also be used to manage symptomatic hemangiomas.