Hemangiomas are common, non-cancerous collections of blood vessels. While they can appear in various parts of the body, this discussion focuses on those found within the spine. These spinal growths are benign and often do not cause any issues. However, in some situations, they can lead to symptoms that require medical attention.
What is a Spinal Hemangioma?
A spinal hemangioma is a benign vascular growth that develops within the vertebral body, the bony segment of the spine. These growths are common, occurring in approximately 10% of the population, and are often discovered by chance during imaging tests performed for other health concerns. They are characterized by an overgrowth of blood vessels and bone tissue.
When viewed on medical imaging, spinal hemangiomas present distinct patterns. On a CT scan, they may show a “polka dot” or “corduroy” appearance due to thickened bony structures and prominent vascular channels within the vertebra. MRI scans reveal a bright signal on T1 and T2-weighted images, which is attributed to the fat and slow-moving blood within the lesion. These characteristic imaging findings help differentiate them from other spinal conditions.
Recognizing the Symptoms
Most spinal hemangiomas do not cause any noticeable symptoms and are discovered incidentally. However, in a small percentage of cases, estimated to be around 0.9% to 5%, they can become symptomatic. Symptoms can arise if the hemangioma grows, bleeds, or presses on the spinal cord or nearby nerves.
When symptoms do occur, they often include localized back pain, which may worsen with activity. Nerve compression can lead to radiating pain, numbness, tingling, or weakness in the arms or legs. Rarely, severe spinal cord compression can cause bladder or bowel control problems.
Diagnostic Approaches
Spinal hemangiomas are frequently identified when a person undergoes imaging for unrelated health problems. Initial evaluation may involve X-rays, which can sometimes show a vertically striated or “corduroy cloth” pattern in the affected vertebra due to thickened bone. However, smaller hemangiomas may not be visible on X-rays.
CT scans provide detailed images of bony structures, revealing the characteristic “polka-dot” or “salt and pepper” pattern caused by thickened bone trabeculae. Magnetic Resonance Imaging (MRI) is considered the most effective diagnostic tool, offering clear visualization of soft tissues. It can assess if the hemangioma extends into the spinal canal or compresses nerves. MRI also shows specific signal patterns, appearing bright on T1 and T2-weighted images due to fat and vascular content.
Treatment and Outlook
Asymptomatic spinal hemangiomas typically do not require treatment; observation is the usual approach. For symptomatic cases, various treatment options relieve pain and address neurological issues. Conservative management, such as pain relief medication and physical therapy, may be considered for mild symptoms.
Minimally invasive procedures like vertebroplasty or kyphoplasty involve injecting bone cement into the vertebra to stabilize it and reduce pain. Kyphoplasty, which uses a balloon to create a cavity before cement injection, may also help restore vertebral height. Radiation therapy can shrink the hemangioma and alleviate compression by damaging its blood vessels. Embolization blocks blood flow to the hemangioma, often performed before surgery to reduce bleeding. In rare situations, especially with severe neurological impairment or spinal instability, surgical removal (vertebrectomy or laminectomy) may be necessary. The outlook for individuals with spinal hemangiomas is favorable, given their benign nature and effective treatments.