A hemangioma is a non-cancerous growth of abnormal blood vessels, often found within the spine. These are considered the most common non-cancerous bone tumor of the spine. They are frequently discovered incidentally during imaging tests for other conditions, and most do not cause symptoms.
Understanding T12 Hemangiomas
The T12 vertebra, located at the thoracolumbar junction, is a common site for hemangiomas, along with other areas of the thoracic and lumbar spine. This junction’s mechanical stress may contribute to their prevalence here. While about 10% of the population may have spinal hemangiomas, only a small percentage (0.9% to 1.2%) ever develop symptoms.
Recognizing Symptoms
When symptoms arise, the most common complaint is localized back pain at the T12 vertebra. This pain can range from mild to severe and may worsen with activity.
More concerning symptoms develop if the hemangioma expands beyond the bone or causes the vertebra to collapse. This can lead to pressure on nearby nerves or the spinal cord, resulting in neurological symptoms. These include weakness, numbness, or a “pins and needles” sensation in the legs, and in rare cases, problems with bowel or bladder control. Such neurological deficits can progress, potentially leading to decreased motor skills or even paralysis if left unaddressed.
How Hemangiomas Are Diagnosed
Diagnosis of a T12 hemangioma begins with a clinical evaluation, including medical history and a physical examination to assess neurological changes.
X-rays can reveal characteristic appearances within the affected vertebra, such as a “corduroy” or “jail bar” pattern on sagittal views, or a “polka-dot” or “salt and pepper” appearance on axial views due to thickened bony structures. Magnetic Resonance Imaging (MRI) is sensitive for assessing soft tissue involvement and detecting spinal cord compression. Computed Tomography (CT) scans provide detailed bone information and identify fractures or the “polka-dot” pattern.
Treatment Options
When a hemangioma becomes symptomatic or aggressive, treatments are considered to alleviate pain and prevent complications.
Minimally invasive procedures like vertebroplasty or kyphoplasty involve injecting bone cement into the affected vertebra for stabilization and pain reduction. Radiation therapy can shrink the lesion and relieve pain, particularly for aggressive or larger hemangiomas, or when surgery is not an option. Embolization, which reduces blood flow by blocking blood vessels, may be performed to minimize bleeding. Surgical intervention is reserved for severe cases, especially those with significant neurological deficits or spinal instability, and may involve decompressing the spinal cord or removing the lesion.
Long-Term Outlook
The long-term outlook for individuals with T12 hemangiomas is favorable. Even for symptomatic cases, appropriate management leads to pain relief and improved neurological function.
Ongoing monitoring with follow-up imaging may be recommended to track the hemangioma’s stability and ensure no progression. Recurrence or growth after treatment is low for most cases. With effective management, individuals can return to their prior activity levels and maintain a good quality of life.