Aggressive vertebral hemangioma of the thoracic spine without typical radiological appearance.
OBJECTIVE
Vertebral hemangioma (VH) is virtually vascular malformation, which is usually asymptomatic. Only 3.7 % of VH may become active and symptomatic, and 1 % may invade the spinal canal and/or paravertebral space. Treatment protocols for active or aggressive VHs are still in controversy. Reported treatments include radiotherapy, vertebroplasty, direct alcohol injection, embolization, surgery and a combination of these modalities.


METHODS
A 41-year-old lady was presented with 18 month history of intermittent back pain. CT revealed T5 osteolytic lesion with epidural and paravertebral extension. The first CT guided biopsy yielded little information.


RESULTS
Histopathological diagnosis of the second biopsy was VH. Vertebroplasty, posterior decompression and fixation were performed followed by postoperative radiotherapy. Her symptoms were resolved immediately after the operation. At 12 months follow-up, no recurrence was detected by CT with contrast enhancement.


CONCLUSIONS
Surgical decompression, vertebroplasty and fixation are safe and effective for aggressive VH. More attention is needed in determining the algorithm for the diagnosis and treatment of aggressive VH.
Orthopaedic Department, Peking University Third Hospital, No 49 North Garden Road, HaiDian District, Beijing, China. danglei_2000@yahoo.com
Lei
L
Dang
Chen
C
Liu
Shao Min
SM
Yang
Liang
L
Jiang
Zhong Jun
ZJ
Liu
Xiao Guang
XG
Liu
Hui Shu
HS
Yuan
Feng
F
Wei
Miao
M
Yu
D000328:Adult; D005260:Female; D006801:Humans; D011859:Radiography; D018714:Radiotherapy, Adjuvant; D012886:Skull / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery; D054079:Vascular Malformations / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000601:surgery*