Options and surgical outcomes of symptomatic vertebral hemangiomas

English Keywords:Hemangioma  Spine  Percutaneous vertebroplasty  Open surgery

English Abstract:

  【Abstract】 Objectives: To investigate the indications of symptomatic vertebral hemangiomas(SVH), and to evaluate the surgical outcomes. Methods: Between July 1998 and June 2013, 49 SVHs were operated in the musculoskeletal tumor center of Peking University People′s Hospital. There were 19 males and 30 females. The average age was 53 years(range, 16-83 years). All patients presented with unremitted pain or neurological deficit(Frankel B-D). For patients with posterior vertebral body wall intact and no sign of spinal instability or neurological deficit, percutaneous vertebroplasty(PVP) was performed(18 patients). Otherwise, open surgery was performed(31 patients). Preoperative and postoperative spinal cord function(Frankel scale), complications and pain(visual analogue scale, VAS) were analyzed respectively. Results: All 18 patients undergoing PVP had no perioperative complication and the average VAS score decreased from 4.4(2-8) to 1.0(0-4)（P<0.01）. After follow-up of 59 months(range, 14-127 months), 2 patients suffered from pain relapse which was relieved by radiotherapy. Among 31 patients who underwent open surgeries, posterior approach, anterior approach, and posterior-anterior combined approach were used in 19, 7 and 5 patients respectively. The average blood loss during operation was 2270ml(range, 300-6000ml). Except for 1 patient who suffered from massive intraoperative hemorrhage and unavailable for instrumentation, 30 patients underwent internal fixation. Two patients suffered from local hematoma and one had skin incision infection. No perioperative death was observed. 3 months after the operation, 14 of the 16 patients presented with an improved Frankel grade. Among the 15 patients with local pain or neurofunction deficit, the average VAS decreased from 4.8(3-9) to 1.3(0-6)（P<0.01）. After a mean follow-up of 76.3 months(range, 14-191 months), 4 patients had local recurrence, 2 cases without symptom were followed up simply, and the other 2 with symptoms were treated successfully with surgery or radiotherapy. Conclusions: For SVH, operative treatment can achieve good clinical curative effect. Open surgery should be considered for those with posterior vertebral body wall broken, huge paravertebral soft tissue mass, compressed dura sac or spinal nerve, and/or spine instability caused by pathologic fracture, otherwise, PVP is a better option.