Spinal hemangiomas are vascular lesions representing a growth of blood vessels within a vertebra (bone of the spine). Although sometimes referred to as a tumor, nearly all spinal hemangiomas are non-cancerous. They are a common discovery during medical imaging, often prompting questions about their nature and whether they will disappear or require treatment.
What Spinal Hemangiomas Are
A spinal hemangioma is a common vascular malformation occurring within the vertebral bodies. These growths consist of an overgrowth of small, thin-walled blood vessels and are classified as benign. They are the most common type of non-cancerous bone tumor found in the spine.
These lesions are typically slow-growing and are most often found in the middle (thoracic) or lower (lumbar) sections. Spinal hemangiomas affect about 10% of the population, but the vast majority cause no symptoms. They are usually discovered incidentally when a patient undergoes a magnetic resonance imaging (MRI) or computed tomography (CT) scan for an unrelated back problem.
Do Spinal Hemangiomas Go Away?
The direct answer to whether a spinal hemangioma goes away on its own is no; these lesions are considered permanent once they form. They are structural abnormalities involving blood vessel proliferation within the bone tissue. They do not involute or shrink away over time once adulthood is reached.
This stability distinguishes them from infantile hemangiomas, often called “strawberry marks” on babies’ skin. Infantile hemangiomas frequently undergo natural regression, shrinking and disappearing as the child ages. Spinal hemangiomas, found primarily in adults and located within the bone, follow a different natural history and are not expected to resolve spontaneously.
Although a small percentage of vertebral hemangiomas may show a slight decrease in size over many years, they are expected to remain present. The vast majority of these lesions remain stable and require no active intervention beyond initial diagnosis.
When Hemangiomas Cause Symptoms
Most spinal hemangiomas are asymptomatic, but in a small number of cases (less than 5%), they can cause problems that require medical attention. Symptoms arise when the lesion grows large enough to disrupt the surrounding structures. This transition from an incidental finding to a symptomatic condition usually involves two main mechanisms.
The first is structural compromise of the vertebra. If the vascular growth replaces too much of the normal, supportive bone tissue, the vertebra can become weakened. This weakening potentially leads to a compression fracture and pain. The weakened bone may collapse, causing chronic back pain localized to that specific area of the spine.
The second, and more concerning, mechanism is neurological compression. This occurs when the hemangioma expands outside the vertebral body and into the spinal canal, where it can press on the spinal cord or the nerve roots. This pressure can manifest as symptoms like radiating pain, numbness, tingling, or weakness in the arms or legs. In rare and severe cases, compression of the spinal cord can lead to serious neurological deficits, such as difficulty walking or loss of bladder control.
Treatment and Management Approaches
The management strategy for a spinal hemangioma is determined by whether it is causing symptoms. For the vast majority of patients with asymptomatic hemangiomas, the recommended approach is watchful waiting and observation. This involves periodic medical check-ups, as regular follow-up imaging is often unnecessary unless new pain or neurological symptoms develop.
When a hemangioma causes pain but no neurological deficit, vertebroplasty is a common, minimally invasive treatment. This involves injecting bone cement into the weakened vertebra to stabilize it. This technique alleviates pain caused by instability and is particularly effective when a compression fracture has occurred.
For symptomatic lesions causing severe pain or neurological issues, other treatments are considered. Transarterial embolization blocks the blood supply to the lesion to shrink it and reduce pressure. Radiation therapy may also be used to destroy the cells and reduce the size. Surgery to remove the affected portion of the vertebra (vertebrectomy) is reserved for the most complex cases where significant spinal cord compression is present and other methods have failed.