Spinal hemangioma
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Spinal hemangioma treatment
- Possible complications and consequences
- Forecast
- Prevention
Spinal hemangioma is a benign neoplasm that affects one or more vertebrae and is one of the most common spinal neoplasias. This is a benign type of tumor that is not prone to malignant degeneration.
Signs of spinal hemangioma
According to various sources, 1–11% of the population suffers from spinal hemangioma. It is most often diagnosed in women in their 20s and 30s. It is extremely rare in childhood. In the general structure of benign skeletal tumors, the hemangioma of the spine is 1–1.5%.
Usually, spinal hemangioma is found in one vertebra, multiple hemangiomas involving 2–5 vertebrae in the pathological process are diagnosed much less frequently.
Synonym: vertebral hemangioma.
Causes and risk factors
The exact causes of the disease have not been established, presumably, genetic predisposition plays the main role. In the presence of close relatives with hemangiomas of different localizations, the risk of spinal hemangioma increases fivefold. It is believed that a vascular tumor forms with excessive physical exertion against the background of a genetically determined weakness of the vascular walls.
Risk factors include high estrogen levels, tissue hypoxia, and spinal injury.
Forms of the disease
Depending on the histological picture, the following forms of spinal hemangioma are distinguished:
- capillary - formed by intertwining capillaries, separated by layers of fibrous and adipose tissue;
- racematous - formed by larger vessels than capillary;
- cavernous - is an accumulation of a large number of cavities of different size and shape, communicating with each other, the walls of which consist of connective tissue covered with a layer of endothelial cells;
- mixed.
Depending on the location and degree of damage, spinal hemangiomas are divided into types:
- The entire vertebra is affected.
- The vertebral body is affected.
- The posterior semi-ring of the vertebra is affected.
- The body and part of the posterior semi-ring of the vertebra are affected.
- The neoplasm is located epidurally.
Examples of spinal hemangioma growth
Vertebral hemangiomas are active (aggressive) and inactive. Based on clinical and radiological criteria for aggressiveness, the following types of spinal hemangiomas are distinguished:
- asymptomatic non-aggressive - there are no clinical and radiological signs of aggressiveness;
- symptomatic non-aggressive - in the presence of clinical manifestations, there are no radiological signs of aggressiveness;
- asymptomatic aggressive - asymptomatic, there are radiological signs of aggressiveness;
- symptomatic aggressive - there are clinical and radiological signs of aggressiveness.
Symptoms
Spinal hemangioma in many cases (according to some data, in 85% of patients) is asymptomatic and is an accidental diagnostic finding during examination for another reason.
The main manifestation of vertebral hemangioma is pain syndrome caused by irritation of the sensitive receptors of the posterior longitudinal ligament and periosteum. The pain, as a rule, has a dull aching character, intensifies after physical exertion and at night. With hemangiomas not exceeding 1 cm, painful sensations occur occasionally, have an aching character. With neoplasms more than 1 cm, the pain is more intense and repeated more often.
The main manifestation of spinal hemangioma is pain syndrome
In some cases, there are signs of irritation of the spinal cord and nerve roots, which is caused by the pressure of the neoplasm located in the epidural space. Approximately 4% of patients experience aggressive neoplasm growth, which causes a decrease in bone strength and can lead to pathological fractures. With the accumulation of blood in the extradural space, sensitivity disorders, paresis, paralysis develop, and the functions of the pelvic organs are disrupted.
The clinical picture also depends on the localization of the tumor in the spine. The most common hemangiomas of the thoracic spine, which account for about 80% of all verterbral hemangiomas. This form of the disease is manifested by weakness, pain and a feeling of numbness in the upper and lower extremities, indigestion and urination disorders, the formation of stones in the gallbladder, and heart rhythm disturbances.
With hemangiomas of the lumbar spine, patients complain of pain in the groin and / or hip, muscle atrophy and weakness of the lower extremities, diarrhea, constipation, urinary incontinence, erectile dysfunction.
Pain in the groin and hip area is characteristic of hemangioma of the lumbar spine
The share of hemangiomas of the cervical spine is approximately 1% in the overall structure of the disease. Their manifestations can be persistent headaches, attacks of dizziness, sleep disturbances, hearing loss and visual acuity, numbness and tingling in the fingers of the upper and lower extremities, dull pain and weakness in the extremities, atrophy of the muscles of the hands.
Diagnostics
To make a diagnosis, it may be necessary to consult a neurologist, oncologist and vertebrologist. Diagnosis of spinal hemangioma is based on the clinical manifestations of the disease, as well as on the data obtained during the instrumental examination.
When carrying out an X-ray examination, structural changes of the vertebra are determined in a reticular, columnar or vacuole-like version. With the mesh version, the neoplasm looks like a fine-mesh sponge. With columnar, bone septa are found, which are clearly visible against the background of the rarefaction zone. With a vacuole-like neoplasm, it is seen in the form of oval-shaped rarefaction zones (vacuoles), which are limited by sclerotically compacted bone.
To diagnose spinal hemangioma, an X-ray examination is performed
Computed tomography or magnetic resonance imaging may be required to clarify the diagnosis. The soft tissue neoplasms in the epidural space and irregularly shaped cells detected with their help are signs of aggressiveness of the spinal hemangioma.
Spinal hemangioma treatment
Treatment of spinal hemangioma depends on the form of the disease. Asymptomatic nonaggressive hemangiomas of the spine do not require therapy. In this, as well as in some other cases, wait-and-see tactics with dispensary observation of the patient are justified.
The method of choice in the treatment of most vertebral hemangiomas is percutaneous puncture vertebroplasty, during which bone cement (from 4 to 7 ml) is injected into the neoplasm by puncture (puncture) with a needle, which causes the vessels or cavities of the hemangioma to be compressed and destroyed. The cavity of the neoplasm is filled with material that ensures the integrity and strength of the affected vertebra. The manipulation is carried out under X-ray control. General anesthesia is not required; local anesthesia is used. Pain sensations subside during the first days after the intervention. The method belongs to minimally invasive surgical operations.
Most vertebral hemangiomas of the spine are destroyed by percutaneous puncture vertebroplasty
Spinal hemangioma embolization can be performed in two ways. During transvasal embolization, emboli are injected into nearby blood vessels, stopping blood flow in them. During selective embolization, emboli are injected into the tumor area. Transvasal embolization is less effective because small vessels that remain after surgery may continue to feed the tumor, increasing the risk of recurrence.
When the spinal cord and nerve roots are squeezed, the affected areas of the bone and soft tissues are resected. This method has limited application due to the relatively high risk of profuse bleeding from cavities or blood vessels that form a neoplasm.
Radiation therapy can be used to treat spinal hemangiomas. As a result of radiation, the blood vessels of the neoplasm collapse, and the soft tissue of the tumor undergoes fibrous degeneration. The method is rarely used due to the possibility of developing neurological disorders.
The method of alcoholization of the hemangioma of the spine consists in the introduction of 96% ethyl alcohol into the neoplasm cavity, which leads to thrombosis of the tumor blood vessels and destruction of the endothelium, followed by a decrease in the size of the neoplasm. The method is not widely used because of the risk of undesirable long-term consequences.
Possible complications and consequences
Complications of spinal hemangioma include bleeding from its vessels, vertebral fractures with the development of neurological disorders caused by compression of nerve endings and spinal cord, stroke.
Forecast
With timely diagnosis and properly selected treatment, the prognosis is favorable.
The likelihood of postoperative complications, depending on the method used, is estimated at 1–10%, long-term consequences of treatment of spinal hemangiomas are extremely rare.
Prevention
In order to prevent the development of the disease, as well as to prevent the growth of an already existing spinal hemangioma, the following measures are recommended:
- regular preventive examinations;
- consultation of a geneticist in the presence of hemangiomas and, in particular, hemangiomas of the spine in a family history;
- sufficient physical activity, but avoidance of excessive physical exertion;
- prevention of spinal injuries;
- balanced diet;
- rejection of bad habits.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
