A spinal hemangioma refers to a common, noncancerous growth of blood vessels that develops within the bones of the spine, known as vertebrae. These growths are frequently discovered by chance during imaging tests performed for unrelated medical reasons. While many spinal hemangiomas remain without symptoms, some can expand and lead to complications that warrant medical attention.
Understanding Spinal Hemangiomas
A spinal hemangioma is a benign vascular tumor, a non-cancerous growth of blood vessels and bone tissue. These tumors are the most common primary tumors found in the spine, developing in the thoracic (mid-back) and lumbar (lower-back) regions. They are slow-growing. Approximately 10% of the population may have spinal hemangiomas, with most individuals not experiencing any symptoms.
Spinal hemangiomas are broadly categorized into two types: cavernous and capillary. Cavernous hemangiomas consist of clusters of enlarged blood vessels and bone tissue. Capillary hemangiomas, on the other hand, form from smaller, thin-walled blood vessels interspersed with normal bone tissue, and can range from small lesions to those that replace entire vertebrae. These lesions do not regress spontaneously.
When a Spinal Hemangioma Becomes Serious
While most spinal hemangiomas remain asymptomatic, a small percentage (0.9% to 5%) can become symptomatic and lead to serious complications. These complications arise when the hemangioma expands, weakens the vertebral bone, or extends into the spinal canal or neural foramina, compressing nerves or the spinal cord.
Localized back pain is a common symptom when a hemangioma becomes serious, often described as a dull ache. This pain can be worsened by movement or axial loading, such as during exercise or housework. The hemangioma can weaken the vertebral bone, potentially leading to compression fractures, which may cause severe pain and instability.
As the hemangioma expands, it can press on the spinal cord or nerve roots, leading to neurological symptoms. These symptoms include numbness, tingling, or weakness in the limbs, often radiating along a nerve pathway. In more severe instances, issues with bladder and bowel control can occur due to spinal cord compression. Though rare, extreme and untreated cases of severe compression have the potential to result in paralysis.
Diagnosis and Management
Spinal hemangiomas are primarily diagnosed through imaging techniques. Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scans are the most effective methods for diagnosis, providing detailed images to assess the tumor’s size, its involvement with the spinal cord, and any nerve compression. On CT scans, hemangiomas may show a “polka-dot” or “salt and pepper” appearance due to thickened bony trabeculae. MRI shows increased signal intensity on T1 and T2-weighted images due to fat within the lesion. While X-rays can sometimes identify a trabecular or lattice-like pattern, MRI is considered definitive for assessing soft-tissue extension.
For asymptomatic hemangiomas, active treatment is not required; monitoring is recommended. However, for symptomatic or complicated cases, various treatment options are available. Embolization involves blocking blood flow to the hemangioma to shrink it, and can sometimes be performed before surgery. Radiation therapy is another approach used to reduce the size of the tumor, proving effective for pain relief and disease control, especially when neurological deficits are developing or surgery is not feasible.
Minimally invasive procedures such as vertebroplasty or kyphoplasty involve injecting bone cement into the weakened vertebra to stabilize it and alleviate pain. Vertebroplasty is useful for spinal stabilization and preventing epidural bleeding in cases of compression fractures. Surgery may be considered for severe nerve compression, spinal instability, or when other treatments have not been effective, sometimes involving the removal of the affected bone or decompression of the spinal cord. With appropriate management, the outlook for individuals with symptomatic spinal hemangiomas is favorable.