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Timilsina K, Shrestha S, Bhatta OP, Paudel S, Lakhey RB, Pokharel RK. Atypical Aggressive Hemangioma of Thoracic Vertebrae Associated With Thoracic Myelopathy-A Case Report and Review of the Literature. Case Rep Orthop 2024; 2024:2307950. [PMID: 39165484 PMCID: PMC11335424 DOI: 10.1155/2024/2307950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/05/2024] [Accepted: 08/02/2024] [Indexed: 08/22/2024] Open
Abstract
Aggressive thoracic hemangiomas are rare, benign tumors that extend into the spinal canal and cause neurological symptoms. Delayed diagnosis and treatment, due to a paucity of literature on optimal treatment strategies, can increase morbidity. This case report describes a 19-year-old male patient with aggressive thoracic hemangioma who presented with upper back pain and progressive weakness of the lower extremities. The patient underwent preoperative embolization and sclerotherapy, followed by decompression, posterior instrumentation, and stabilization. The final diagnosis was confirmed by biopsy, and there was a significant improvement in neurology after the surgical intervention. The diagnosis of rare lesions, such as aggressive hemangiomas, requires a high level of clinical suspicion and the assistance of imaging modalities in patients with features of compressive myelopathy. A combination of endovascular and surgical approaches can lead to optimal outcomes.
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Affiliation(s)
| | - Sandesh Shrestha
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Sushil Paudel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rajesh Bahadur Lakhey
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Rohit Kumar Pokharel
- Department of Orthopaedics and Trauma SurgeryTribhuvan University Teaching Hospital, Kathmandu, Nepal
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Xu W, Lan Z, Huang Y. Intraoperative injection of absorbable gelatin sponge (AGS) mixed with cement followed by spinal decompression to treat elderly with vertebral hemangiomas. BMC Musculoskelet Disord 2020; 21:125. [PMID: 32093675 PMCID: PMC7041297 DOI: 10.1186/s12891-020-3143-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
Background Elderly patients with vertebral hemangiomas are rare and might require surgery. Thus, the choice of surgery for these lesions remains controversial because of the rarity of these lesions. This study aimed to analyze the clinical efficacy of the intraoperative injection of absorbable gelatin sponge mixed with cement followed by spinal decompression to treat the elderly with typical vertebral hemangiomas. The risk factors for hemangioma recurrence were investigated through a literature review. Methods We retrospectively analyzed 13 patients with typical aggressive hemangiomas between January 2009 and January 2016. Of these patients, 7 were treated with spinal decompression combined with intraoperative vertebroplasty (Group A), and 6 patients were treated with decompression with intraoperative vertebroplasty and absorbable gelatin sponge (Group B). The general data and perioperative data of the patients were compared. Patients were followed up for at least 3 years, and postoperative complications and recurrence rates were recorded and compared. Results All patients had typical aggressive hemangiomas. The average age of all patients was 64.4 ± 3.3 years. The preoperative data did not differ significantly between the two groups (P > 0.05). The blood loss of groups A and B was 707.1 ± 109.7 ml and 416.7 ± 103.3 ml, respectively (P = 0.003) (P = 0.003), and the average surgery durations were 222 ± 47.8 min and 162 ± 30.2 min, respectively (P = 0.022). The average follow-up duration was 62 ± 19 months, and no cases of recurrence were found at the final follow-up assessment. Conclusions Multimodal treatment significantly alleviated the clinical symptoms of elderly patients with typical aggressive vertebral hemangiomas. Intraoperative absorbable gelatin sponge injection is a safe and effective way to reduce blood loss and surgery duration.
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Affiliation(s)
- Weihong Xu
- Department of Spine Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Zhibin Lan
- Department of Spine Surgery, Quanzhou Orthopedic-Traumatological Hospital of Fujian Traditional Chinese Medicine University, Quanzhou, 362000, Fujian, China
| | - Yuming Huang
- The Orthopedics Department, Fuzhou Second Hospital affiliated to Xiamen University, Cangshan District, Fuzhou, 350007, Fujian, China.
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Wang B, Zhang L, Yang S, Han S, Jiang L, Wei F, Yuan H, Liu X, Liu Z. Atypical Radiographic Features of Aggressive Vertebral Hemangiomas. J Bone Joint Surg Am 2019; 101:979-986. [PMID: 31169574 DOI: 10.2106/jbjs.18.00746] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vertebral hemangioma (VH) is one of the most common benign spinal tumors and can be aggressive in some cases. While most aggressive VHs have typical radiographic features, including vertical striations, a honeycomb appearance, and/or a "polka-dot sign" in computed tomography (CT) scans, cases with atypical features might complicate diagnosis. This study aimed to determine the range and frequency of these atypical features. METHODS In this retrospective study, to identify the typical and atypical features of aggressive VH, pretreatment CT and magnetic resonance imaging (MRI) were reviewed retrospectively by 1 radiologist and 1 orthopaedic surgeon. Percutaneous biopsies were performed to confirm the VH in atypical cases. RESULTS A total of 95 patients with aggressive VHs were treated in our hospital from January 2005 to December 2017. Thirty-four (36%) of the lesions showed at least 1 atypical radiographic feature: 16 patients (17%) had a vertebral compression fracture, 11 patients (12%) had expansive and/or osteolytic bone destruction without a honeycomb appearance and/or "polka-dot sign", 11 patients (12%) had obvious epidural osseous compression of the spinal cord, 12 patients (13%) had involvement of >1 segment, 9 patients (10%) had a VH centered in the pedicle and/or lamina, and 8 patients (8%) had atypical MRI signals. Forty-three patients underwent percutaneous biopsies, which had an accuracy of 86%. CONCLUSIONS Based on radiographic analysis, aggressive VH can be classified as typical or atypical. More than one-third of aggressive VH lesions may have at least 1 atypical feature. CT-guided biopsies are indicated for these atypical cases.
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Affiliation(s)
- Ben Wang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China.,Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Lihua Zhang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Shaomin Yang
- Department of Pathology (S.Y.), Peking University Health and Science Center (B.W.), Beijing, China
| | - Songbo Han
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Liang Jiang
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Feng Wei
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Huishu Yuan
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Xiaoguang Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
| | - Zhongjun Liu
- Orthopaedic Department (B.W., L.J., F.W., X.L., and Z.L.) and Department of Radiology (L.Z., S.H., and H.Y.), Peking University Third Hospital, Beijing, China
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