Understanding Vertebral Hemangiomas
A hemangioma is a common type of benign vascular growth. These growths consist of an accumulation of extra blood vessels. While hemangiomas can appear in various parts of the body, this article focuses specifically on those found within the spinal bones, known as vertebral hemangiomas.
A vertebral hemangioma represents a benign vascular tumor composed of abnormal blood vessels located within the vertebral body, which is the main part of a spinal bone. These growths are almost always benign and are not cancerous. They are considered the most common benign tumors of the spine.
These hemangiomas are quite common. They typically occur in the thoracic (mid-back) and lumbar (lower back) regions of the spine. The exact cause of vertebral hemangiomas remains unknown, but they are generally considered to be congenital, meaning they are present from birth, or develop early in life.
How Vertebral Hemangiomas Are Discovered
Many vertebral hemangiomas are discovered incidentally when imaging studies, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, are performed for other medical conditions. They are frequently discovered during examinations for unrelated reasons. For example, they might be identified during an MRI for persistent back pain. This incidental discovery is the most common way these lesions come to light. For the majority of individuals, these spinal vascular lesions cause no symptoms.
While most vertebral hemangiomas are asymptomatic, a small percentage can cause symptoms if they expand or affect surrounding spinal structures. The most common symptom is localized back pain, which can occur if the hemangioma enlarges within the vertebral body. In rare instances, if the hemangioma grows large enough to protrude into the spinal canal or compress the spinal cord or nerves, neurological symptoms can develop, including numbness, weakness, or tingling in the limbs.
The diagnostic process primarily relies on advanced imaging techniques. MRI scans are effective for identifying vertebral hemangiomas, as they reveal a characteristic appearance. CT scans can also show the presence of these lesions, often displaying a unique “polka-dot” or “corduroy” pattern within the vertebra. X-rays provide less detailed information compared to MRI or CT scans.
Managing Vertebral Hemangiomas
Most vertebral hemangiomas are asymptomatic and do not require active medical treatment. For these individuals, the primary approach is observation. This often means no specific follow-up imaging is necessary if the hemangioma is small, stable, and causes no symptoms.
Treatment is typically considered only if the vertebral hemangioma causes significant pain or leads to neurological symptoms due to spinal cord or nerve compression. The choice of treatment depends on the specific situation, including the severity of symptoms, the size and location of the hemangioma, and the presence of any neurological compromise.
Several treatment options exist for symptomatic vertebral hemangiomas. Radiation therapy may be used to shrink the lesion by damaging the blood vessels within it, reducing its size and relieving pressure. Embolization is another technique where a substance is injected into the blood vessels supplying the hemangioma to block blood flow. Vertebroplasty or kyphoplasty procedures involve injecting bone cement into the affected vertebra to stabilize it and reduce pain; though these are more commonly used for vertebral compression fractures, they can be considered for certain painful hemangiomas. In rare and severe cases where there is significant spinal cord compression, surgical intervention may be performed to remove part of the hemangioma and decompress the spinal cord or nerves.