Spinal hemangiomas are common, non-cancerous vascular lesions within the bones of the spine. They are often discovered incidentally during imaging for other conditions. Most are asymptomatic and do not require intervention.
Understanding Spinal Hemangiomas
A spinal hemangioma is a benign tumor formed from an overgrowth of blood vessels within the vertebrae, which are the bony segments making up the spinal column. These lesions are considered the most common non-cancerous bone tumor of the spine. They are quite prevalent, affecting an estimated 10% to 12% of the general population.
Most spinal hemangiomas are small and stable, meaning they do not grow or change over time. They often occur in the thoracic (mid-back) and lumbar (lower-back) regions of the spine. Less than 5% of individuals with a spinal hemangioma will experience symptoms related to the lesion.
Recognizing Concerning Symptoms
While most spinal hemangiomas are harmless, some can grow or cause complications, leading to symptoms that warrant medical attention. These symptoms arise when the hemangioma expands, bleeds, or presses on nearby structures like the spinal cord or nerves. Localized pain that worsens over time or with movement is a common concerning symptom.
Neurological deficits can also signal a problematic hemangioma. These include numbness, tingling, or weakness in the arms or legs. More serious cases may involve changes in gait, difficulty walking, or issues with bowel or bladder function. Such symptoms indicate potential compression of the nervous system, necessitating prompt medical evaluation.
Diagnostic Approaches
When symptoms suggest a spinal hemangioma is causing issues, various diagnostic tools are used to evaluate the lesion. Magnetic Resonance Imaging (MRI) is the primary imaging modality, providing detailed views of the spinal cord, nerves, and surrounding soft tissues. An MRI determines the hemangioma’s size, exact location, and whether it is compressing neural structures.
Other imaging techniques, such as Computed Tomography (CT) scans and X-rays, may also be used. A CT scan can reveal a characteristic “polka-dot” or “corduroy” appearance within the affected vertebra. X-rays can sometimes show a specific trabecular pattern in the bone. These studies help confirm the hemangioma’s presence and if it is the cause of symptoms.
Management and Outlook
The management of spinal hemangiomas depends on whether they are causing symptoms. Asymptomatic hemangiomas typically require no specific treatment, with observation usually recommended. For symptomatic cases, several treatment options are available, chosen based on the hemangioma’s size, location, and its impact on the spinal cord or nerves.
Treatment approaches include embolization, which blocks the blood supply to shrink the tumor. Vertebroplasty or kyphoplasty involves injecting bone cement into the affected vertebra to stabilize it and alleviate pain. Radiation therapy can shrink the hemangioma, particularly for pain relief or when surgery is not an option. In rare instances, surgical removal of the hemangioma or part of the vertebra may be considered for large tumors causing significant compression. Most spinal hemangiomas, even if symptomatic, can be effectively managed, allowing individuals to maintain a good quality of life.