Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas

OBJECTIVE: We analyzed the outcome of patients with symptomatic vertebral hemangiomas treated at University of California, San Francisco, over a 20 year period. Treatment included transarterial embolization, embolization followed by surgical decompression or vertebral reconstruction with arthrodesis, and percutaneous vertebroplasty alone. METHODS: All medical, surgical, and radiological records were reviewed retrospectively. All patients underwent follow-up neurological examination and evaluation of back pain. RESULTS: Sixteen patients diagnosed with symptomatic vertebral hemangiomas causing pain or neurological deficit were treated at University of California, San Francisco, between 1984 and 2004. Mean follow-up was 81 months. Seven of nine patients undergoing surgical decompression and tumor resection reported pain relief and demonstrated improvement in neurological deficit when present. Two patients had recurrent myelopathy: one was successfully treated with a second decompressive surgery, whereas the second underwent a staged vertebrectomy. All three patients undergoing vertebrectomy had cord compression from extraosseous tumor growth. Preoperative embolization reduced expected intraciperative blood loss in four patients. Three of four patients who underwent transarterial embolization alone experienced resolution of back pain. Two of four patients treated with vertebroplasty had long-term pain relief. CONCLUSION: Transarterial embolization followed by laminectomy is a safe and effective procedure for the treatment of cord compression by vertebral hemangioma causing stenosis without instability or deformity. Vertebrectomy preceded by embolization and followed by reconstruction can be used to treat cord compression from extraosseous tumor extension. Transarterial embolization without decompression is an effective treatment for painful intraosseous hemangiomas. Vertebroplasty is useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit, but is less effective in providing long-term pain relief.