Surgical treatment of aggressive vertebral hemangiomas with compressive myelopathy

English Keywords:Spine hemangioma  Spinal cord compression  Spondylectomy  Decompression

English Abstract:

  【Abstract】 Objectives: To investigate the surgical methods for the aggressive vertebral hemangiomas with compressive myelopathy. Methods: Twenty-six patients suffering from aggressive vertebral hemangiomas with compressive myelopathy between January 2000 and October 2015 were reviewed. There were 11 males and 15 females, with the age of 15-69 years(23.0±4.5 years). Solitary tumors occurred in 6 patients and multiple tumors in 20 patients. The responsible segment located at cervical spine in 6 cases, thoracic spine in 18 cases and lumbar spine in 2 cases. The Frankel grade ranked A in 1 case, C in 5 cases, D in 18 cases, E in 2 cases. The ESCC grade was Ⅰ in 5 cases, Ⅱ in 15 cases, Ⅲ in 6 cases. The pathologic diagnosis was clear in 18 cases through preoperative needle biopsy and 8 cases through intraoperative fast pathologic examination. The operation applied decompression, vertebroplasty and internal fixation in 11 cases, vertebral tumor resection and reconstruction through anterior approach in 6 cases, total spondylectomy through posterior approach in 8 cases, tumor resection and reconstruction through one-stage combined anterior and posterior approach for axial hemangiomas in 1 case. The assessments included intraoperative blood loss, perioperative complications, tumor control, spinal cord function and spinal stability. Results: The average blood loss was 3927±4137ml in 15 cases with the vertebral tumor resection and 1355±703ml in 11 cases with decompression and vertebroplasty. The postoperative complications included pleural hemorrhage in 1 case and delay infection in 1 case, which were cured by using corresponding treatment. The follow-up time was 12-194 months(75±51 months). The tumor progression occurred in 4 cases, in whom 3 cases in decompression group were treated by total spondylectomy(2 cases) and stereotactic radiosurgery(1 case), the other 1 patient with axis tumor progressed after delivery and was treated by decompressive surgery and radiotherapy. The internal fixation related complications occurred in 4 cases, including 3 cases of internal fixation loosening, 1 case of internal fixation fracture, which were all treated with revision surgery. The Frankel grade was D in 4 cases and E in 22 cases at half year after operation. Conclusions: Aggressive spinal hemangioma with spinal cord compression requires surgical treatment. The vertebral resection gains better decompression and tumor controlling, but with huge surgical trauma, more intraoperative bleeding and postoperative complications. Palliative decompression combined with vertebroplasty can also save the spinal cord function, but will face the risk of tumor recurrence in some patients who recover well after spondylectomy.