Surgical treatment of cervical vertebral hemangioma associated with adjacent cervical spondylotic myelopathy.
BACKGROUND
Symptoms may vary from simple vertebral pain to progressive neurologic deficit because of cervical vertebral hemangioma associated with adjacent cervical spondylotic myelopathy (CVHAWACSM). Often resistant to conservative medical treatment, surgery has been the treatment of choice for these patients, but the optimal surgical strategy for CVHAWACSM has not been defined.


OBJECTIVE
This study aimed to investigate the methods and efficacy in the treatment of CVHAWACSM.


METHODS
Retrospective review of patients enrolled in prospective randomized trial.


METHODS
Procedure was performed in 18 patients (11 men and 7 women) with CVHAWACSM, who were enrolled between January 2006 and September 2011.


METHODS
Radiographic examinations were carried out to assess total filling of polymethylmethacrylate in the vertebral body, fusion rates, implant failure, and general complications. The recovery of neurologic function and neck and shoulder pain relief were measured based on the Japanese Orthopedic Association (JOA) and the visual analog scale (VAS) scores.


METHODS
Eighteen patients had single vertebral hemangioma, including one case at C₃, three at C₄, six at C₅, five at C₆, and three at C₇. The X-ray films showed a typical "palisade" change. According to the clinical and imaging features, there were 12 cases of Type II and 6 of Type IV cervical hemangioma. Standard anterior cervical decompression and fusion with a stand-alone polyetheretherketone cage (filled with autologous cancellous iliac bone) was performed, followed by vertebroplasty. Clinical and radiologic follow-ups were performed.


RESULTS
The mean follow-up was 24.1 months, with a range of 18 to 36 months. The symptoms of all 18 patients were improved, by varying degrees, and the lesion vertebra did not show anterior bone cement leakage or injuries in the spinal cord and nerves. The forming vertebra did not show fracture or collapse, and there was no recurrence of the hemangioma. During the follow-up, there was no implant loosening, displacement, or breakage. The JOA and the VAS scores were significantly recovered at 3 months after the operation and in the last follow-up, compared with the preoperative level (p<.05). The JOA scores in the last follow-up showed 13 excellent, 4 good, 1 fair, and 0 poor cases.


CONCLUSIONS
This procedure seems to be a safe efficient method to treat symptomatic CVHAWACSM. It seems to serve the purpose of providing vertebral augmentation, cord decompression, and rigid fusion at the same sitting. Although the present outcomes are promising, long-term follow-up studies with larger patient numbers are required to confirm this effect.
Department of Orthopaedics, The First Affiliated Hospital, Zhengzhou University, No.1, Eastern Jianshe Road, Zhengzhou 450052, China. Electronic address: haojack77@126.com.
Ying-jie
YJ
Hao
Lei
L
Yu
Yan
Y
Zhang
Li-min
LM
Wang
Jia-zhen
JZ
Li
D000328:Adult; D000368:Aged; D017586:Diskectomy / Q000379:methods; D005260:Female; D006391:Hemangioma / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*; D013125:Spinal Neoplasms / Q000601:surgery*; D055009:Spondylosis / Q000601:surgery*
ACDF; Cervical spondylotic myelopathy; PEEK; Vertebral hemangioma; Vertebroplasty