title: Management of symptomatic vertebral hemangioma: follow-up of 6 patients.
abstract: METHODS
  Retrospective study.
  
  
  OBJECTIVE
  To analyze our experience in the treatment of symptomatic vertebral hemangioma, review the relevant literature, and propose a management algorithm.
  
  
  BACKGROUND
  Hemangioma is one of the commonest benign neoplasms affecting the vertebral column. These usually dormant lesions may become symptomatic by causing pain, neurologic deficit, or both. Several treatment modalities are available in the management of such symptomatic conversion.
  
  
  METHODS
  The clinical and radiographic data of 6 patients diagnosed with symptomatic vertebral hemangioma and treated at our medical center over a period of 10 years were reviewed and analyzed retrospectively.
  
  
  RESULTS
  Six patients were diagnosed with symptomatic vertebral hemangioma between 1998 and 2008. The lesions occupied the thoracic, lumbar, or multiple segments. Our patients presented with either simple or radicular back pain. One patient had muscle weakness, 3 revealed sensory impairment, and the remaining 2 were neurologically intact. Four patients underwent preoperative transarterial embolization followed by laminectomy and vertebroplasty of the affected level and 2 patients were treated with vertebroplasty alone. A 35-year-old woman presented during pregnancy. Her clinical course during evaluation was complicated by an acute pulmonary embolic event that necessitated installation of an inferior vena cava filter. All patients had an overall uneventful postoperative course and reported symptomatic relief to varying degrees, at an average follow-up period of 35 months.
  
  
  CONCLUSIONS
  Symptomatic hemangioma involving the vertebral column may pose a therapeutic challenge, often requiring the active involvement of several disciplines. A review of the relevant literature, however, discloses only few management algorithms for such lesions. The coupling of preoperative transarterial embolization followed by vertebroplasty, with or without surgical decompression depending on the patients' presenting symptoms, is a relatively safe treatment and may offer long-term symptomatic relief in these patients. Other aspects of treatment are further discussed.
authors.affiliation: Spine Unit, Department of Orthopedics, Assaf Harofeh Medical Center, Zerifin, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Blecher
authors.forename: Yossi
authors.initials: Y
authors.lastname: Smorgick
authors.forename: Yoram
authors.initials: Y
authors.lastname: Anekstein
authors.forename: Amir
authors.initials: A
authors.lastname: Peer
authors.forename: Yigal
authors.initials: Y
authors.lastname: Mirovsky
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006391:Hemangioma / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011859:Radiography; D012189:Retrospective Studies; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D054854:Vertebroplasty / Q000379:methods*