A hemangioma is a common, non-cancerous growth characterized by an abnormal collection of blood vessels. These vascular growths can develop in various parts of the body, including the skin, internal organs, and bones.
Understanding Spinal Hemangiomas
Spinal hemangiomas are the most common type of benign tumor found in the spine, affecting an estimated 10% of the global population. These lesions are typically located within the vertebral body. The T11 vertebra, in the thoracic (mid-back) region, is a common site for these growths.
Most spinal hemangiomas are small, slow-growing, and often discovered incidentally during imaging tests for unrelated conditions. On imaging, they have characteristic appearances due to their composition of blood vessels and fatty tissue. The presence of fatty components within the lesion typically indicates an inactive form of the hemangioma.
Recognizing Symptoms and Potential Impact
While the majority of spinal hemangiomas remain asymptomatic, a small percentage can become problematic. When symptoms do occur, they often include localized back pain, which can be worsened by activity. This pain may result from the hemangioma expanding within the vertebral body or causing tiny fractures.
In rare instances, a spinal hemangioma can expand aggressively, extending beyond the bone into the spinal canal or putting pressure on the spinal cord or nerve roots. This can lead to neurological symptoms such as weakness, numbness, or a tingling sensation in the arms or legs, or even difficulties with bladder or bowel control. Although rare, a rupture of the hemangioma leading to bleeding can also occur, causing sudden compression and requiring immediate medical attention.
Diagnosis and Monitoring
Spinal hemangiomas are typically identified through various imaging techniques. X-rays can reveal a characteristic trabecular or lattice-like pattern within the affected vertebra, sometimes described as a “corduroy cloth” or “jail bar” appearance. Computed Tomography (CT) scans are useful for detecting a “polka-dot” appearance, which is a classic sign of these lesions, and can also assess for bone destruction or extension into soft tissues.
Magnetic Resonance Imaging (MRI) provides detailed images that help characterize the lesion, showing increased signal intensity on both T1 and T2-weighted images due to the presence of fat and water within the hemangioma. MRI is particularly valuable for evaluating potential spinal cord involvement or nerve compression. For asymptomatic hemangiomas, healthcare professionals often recommend periodic monitoring with imaging.
Treatment Approaches and Outlook
For the vast majority of spinal hemangiomas that do not cause symptoms, a watchful waiting approach with regular monitoring is typically recommended. However, when a hemangioma becomes symptomatic, treatment options are available and are tailored to the individual’s specific condition and symptoms.
Pain management is an initial step for symptomatic cases. For those with persistent pain or neurological issues, radiation therapy can be used to shrink the lesion and reduce symptoms. Procedures like vertebroplasty or kyphoplasty involve injecting bone cement into the affected vertebra to stabilize it and alleviate pain, particularly from microfractures.
In very rare instances where there is significant spinal cord compression or severe neurological deficits, surgical removal of part of the vertebra (vertebrectomy or laminectomy) may be considered to decompress the spinal cord. The overall outlook for individuals with spinal hemangiomas is generally positive, as most are benign and manageable.