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Vertebroplasty in the treatment of symptomatic vertebral haemangiomas without neurological deficit

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Abstract

Objective

To evaluate the effectiveness of vertebroplasty in symptomatic vertebral haemangiomas (VHs) with no neurological deficit, with or without features of aggressiveness in imaging studies.

Methods

A retrospective study was conducted to review 31 consecutive patients with symptomatic VHs that underwent vertebroplasty procedures (13 males, 18 females; mean age, 57.5 years), for a total of 33 affected vertebral levels (range, T4–L5 levels). Pre procedure radiological examinations were reviewed. The presence of predominant soft tissue stroma on CT, low signals on T1W of MRI, epidural tissue, and cortical erosion are considered features of aggressiveness. The clinical effects were evaluated using the visual analogue scale (VAS) and modified Roland–Morris Disability Questionnaire (RDQ) at the pre and each postoperative follow-up time point (mean follow-up of 15.8 months).

Results

Symptomatic VHs with no signs of aggressiveness were observed in 26 lesions and those with signs of aggressiveness in 7 lesions. Vertebroplasty was successfully performed under fluoroscopic guidance with a unipedicular approach in 16 levels, a bipedicular approach in 17 levels. VAS scores and RDQ scores were significantly improved after vertebroplasty (P < 0.001). Extraosseous cement leakage was observed in 4 patients without clinical complications.

Conclusions

Vertebroplasty is an optional treatment for symptomatic VHs with no neurological deficit.

Key Points

• Vertebral haemangiomas with or without aggressive signs may cause pain.

• Radiological signs of aggressiveness include evidence of lesions that contain less fat predominance, evidence of epidural soft tissue and evidence of cortical erosion.

• Vertebroplasty provides effective treatment for symptomatic vertebral haemangiomas causing no neurological deficit.

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References

  1. Chen HI, Heuer GG, Zaghloul K, Simon SL, Weigele JB, Grady MS (2007) Lumbar vertebral hemangioma presenting with the acute onset of neurological symptoms. Case report. J Neurosurg Spine 7:80–85

    Article  PubMed  Google Scholar 

  2. Nguyen JP, Djindjian M, Gaston A (1987) Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol 27:391–397

    Article  PubMed  CAS  Google Scholar 

  3. Kato S, Kawahara N, Murakami H et al (2010) Surgical management of aggressive vertebral hemangiomas causing spinal cord compression: Long term clinical follow-up of five cases. J Orthop Sci 15:350–356

    Article  PubMed  Google Scholar 

  4. Acosta FL Jr, Dowd CF, Chin C, Tihan T, Ames CP, Weinstein PR (2006) Current treatment strategies and outcomes in the management of symptomatic vertebral hemangiomas. Neurosurgery 58:287–295

    Article  PubMed  Google Scholar 

  5. Heyd R, Seegenschmiedt MH, Rades D et al (2010) Radiotherapy for symptomatic vertebral hemangiomas: results of a multicenter study and literature review. Int J Radiat Oncol Biol Phys 77:217–25

    Article  PubMed  Google Scholar 

  6. Guarnieri G, Ambrosanio G, Vassallo P et al (2009) Vertebroplasty as treatment of aggressive and symptomatic vertebral hemangiomas: Up to 4 years of follow-up. Neuroradiology 51:471–476

    Article  PubMed  CAS  Google Scholar 

  7. Brunot S, Berge J, Barreau X, Ménégon P, Dousset V (2005) Long term clinical follow up of vertebral hemangiomas treated by percutaneous vertebroplasty. J Radiol 86:41–47

    Article  PubMed  CAS  Google Scholar 

  8. Deramond H, Darrasson R, Galibert P (1989) Percutaneous vertebroplasty with acrylic cement in the treatment of aggressive spinal angiomas. Rachis 1:146–153

    Google Scholar 

  9. Jensen ME, Evans AJ, Mathis JM, Kallmes DF, Cloft HJ, Dion JE (1997) Percutaneous polymethylmethacrylate vertebroplasty in the treatment of osteoporotic vertebral body compression fractures: Technical aspects. AJNR Am J Neuroradiol 18:1897–1904

    PubMed  CAS  Google Scholar 

  10. Sun G, Jin P, Li M et al (2011) Percutaneous vertebroplasty for pain management in spinal metastasis with epidural involvement. Technol Cancer Res Treat 10:267–274

    PubMed  CAS  Google Scholar 

  11. Sun G, Jin P, Li M et al (2012) Three-dimensional C-arm computed tomography combined with fluoroscopic guided pediculoplasty for treatment of vertebral body metastasis with lytic pedicle. Technol Cancer Res Treat 11:169–174

    PubMed  CAS  Google Scholar 

  12. Roland M, Morris R (1983) A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144, Phila Pa 1976

    Article  PubMed  CAS  Google Scholar 

  13. Laredo JD, Reizine D, Bard M, Merland JJ (1986) Vertebral hemangiomas: Radiologic evaluation. Radiology 161:183–189

    PubMed  CAS  Google Scholar 

  14. Hao J, Hu Z (2012) Percutaneous cement vertebroplasty in the treatment of symptomatic vertebral hemangiomas. Pain Physician 15:43–49

    PubMed  Google Scholar 

  15. Doppman JL, Oldfield EH, Heiss JD (2000) Symptomatic vertebral hemangiomas: Treatment by means of direct intralesional injection of ethanol. Radiology 214:341–348

    PubMed  CAS  Google Scholar 

  16. Pastushyn AI, Slin'ko EI, Mirzoyeva GM (1998) Vertebral hemangiomas: diagnosis, management, natural history and clinicopathological correlates in 86 patients. Surg Neurol 50:535–547

    Article  PubMed  CAS  Google Scholar 

  17. Ross JS, Masaryk TJ, Modic MT, Carter JR, Mapstone T, Dengel FH (1987) Vertebral hemangiomas: MR imaging. Radiology 165:165–169

    PubMed  CAS  Google Scholar 

  18. Laredo JD, Assouline E, Gelbert F, Wybier M, Merland JJ, Tubiana JM (1990) Vertebral hemangiomas: Fat content as a sign of aggressiveness. Radiology 177:467–472

    PubMed  CAS  Google Scholar 

  19. Acosta FL Jr, Sanai N, Chi JH et al (2008) Comprehensive management of symptomatic and aggressive vertebral hemangiomas. Neurosurg Clin N Am 19:17–29

    Article  PubMed  Google Scholar 

  20. Smith TP, Koci T, Mehringer CM et al (1993) Transarterial embolization of vertebral hemangioma. J Vasc Interv Radiol 4:681–685

    Article  PubMed  CAS  Google Scholar 

  21. Guedea F, Majó J, Guardia E, Canals E, Craven-Bartle J (1994) The role of radiation therapy in vertebral hemangiomas without neurological signs. Int Orthop 18:77–79

    Article  PubMed  CAS  Google Scholar 

  22. Nguyen JP, Djindjian M, Gaston A et al (1987) Vertebral hemangiomas presenting with neurologic symptoms. Surg Neurol 27:391–397

    Article  PubMed  CAS  Google Scholar 

  23. Niemeyer T, McClellan J, Webb J, Jaspan T, Ramli N (1999) Brown-Sequard syndrome after management of vertebral hemangioma with intralesional alcohol. A case report. Spine 24:1845–1847, Phila Pa 1976

    Article  PubMed  CAS  Google Scholar 

  24. Muto M, Perrotta V, Guarnieri G et al (2008) Vertebroplasty and kyphoplasty: Friends or foes? Radiol Med 113:1171–1184

    Article  PubMed  CAS  Google Scholar 

  25. Laredo JD, Hamze B (2004) Complications of percutaneous vertebroplasty and their prevention. Skeletal Radiol 33:493–505

    Article  PubMed  CAS  Google Scholar 

  26. Fox MW, Onofrio BM (1993) The natural history and management of symptomatic and asymptomatic vertebral hemangiomas. J Neurosurg 78:36–45

    Article  PubMed  CAS  Google Scholar 

  27. Bandiera S, Gasbarrini A, De Iure F, Cappuccio M, Picci P, Boriani S (2002) Symptomatic vertebral hemangioma: the treatment of 23 cases and a review of the literature. Chir Organi Mov 87:1–15

    PubMed  CAS  Google Scholar 

  28. Cotten A, Deramond H, Cortet B et al (1996) Preoperative percutaneous injection of methyl methacrylate and N-butyl cyanoacrylate in vertebral hemangiomas. AJNR Am J Neuroradiol 17:137–14

    PubMed  CAS  Google Scholar 

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Acknowledgements

This study was supported by grants no. 51073173 from National Natural Science Foundation of China (NSFC).

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Authors and Affiliations

  1. Department of Medical Imaging, Jinan Military General Hospital, No,25, Shifan Road, Jinan, Shandong, China, 250031

    Xun-wei Liu, Peng Jin, Min Li & Gang Sun

  2. Department of Radiology, Huantai People’s Hospital, No.2198 Huantai Avenue, Zibo, Shandong, China, 256400

    Li-jun Wang

Authors
  1. Xun-wei Liu
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  2. Peng Jin
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  3. Li-jun Wang
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  4. Min Li
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  5. Gang Sun
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Correspondence to Gang Sun.

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Liu, Xw., Jin, P., Wang, Lj. et al. Vertebroplasty in the treatment of symptomatic vertebral haemangiomas without neurological deficit. Eur Radiol 23, 2575–2581 (2013). https://doi.org/10.1007/s00330-013-2843-9

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  • DOI: https://doi.org/10.1007/s00330-013-2843-9

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