Percutaneous Cement Vertebroplasty in the Treatment of Symptomatic Vertebral Hemangiomas

Abstract

Background: Vertebral hemangiomas are benign tumors with a rich vasculature. Symptoms may vary from simple vertebral pain, sometimes resistant to conservative medical treatment, to progressive neurological deficit. Surgery or radiotherapy have been the treatment of choice for several years, but they were worsened by intraoperative and postoperative hemorrhagic complications related to the rich vascularization that characterize these kinds of lesions, often preceded by a preoperative embolization in the acute setting. Recently, a percutaneous, minimally invasive technique of vertebroplasty has been introduced into clinical practice as an alternative to traditional surgical and radiotherapy treatment of symptomatic vertebral hemangiomas with or without features of aggressiveness at imaging studies. Objective: This study aimed to illustrate the validity of treatment with percutaneous vertebroplasty (PVP) in patients with symptomatic vertebral hemangiomas (VHs). Study Design: PVP in 26 patients with symptomatic VHs and its clinical effects were evaluated in 3-24 months follow-up. Setting: An inteventional pain management practice, a medical center, major metropolitan city, China. Methods: Twenty-six consecutive patients were treated with PVP; a total of 28 vertebral bodies. All patients were followed-up for 3-24 months, average 8.6 months. The clinical effects were evaluated with the visual analog scale (VAS) and 36-item short-form (SF-36) at preoperative and postoperative and final follow-up, comparing imaging before and post-treatment. Results: Twenty-six patients (28 vertebral bodies) were treated successfully with a satisfying resolution of painful symptoms within 24 to 72 hours. Cement distribution was always diffuse and homogeneous. We found paravertebral cement leakage in 3 cases without any onset of radicular symptoms related to epidural diffusion. Spinal canal and intervertebral foramen cement leakage wasn’t noticed. No pulmonary embolism ever occurred and no clinical and symptomatic complications were observed. Hemangioma was confirmed by pathology examination. VAS scores decreased from 7.5 ± 1.5 preoperatively to 1.6 ± 0.6 postoperatively, with a final score of 0.7 ± 0.5. There was significant difference between postoperative and preoperative, and between final followup and preoperative (P < 0.05). At the postoperative and final follow-up, the SF-36 scores of patients was significantly higher than the preoperative in Role Physical, Bodily Pain, General Health, Vitality, Social Functioning, Role Emotional, and Mental Health (P < 0.05). Limitations: An observational study with a relatively small sample size. Conclusions: PVP is an effective technique to treat symptomatic vertebral hemangioma, which is a valuable, minimally invasive, and quick method that allows a complete and lasting resolution of painful vertebral symptoms. Key words: Percutaneous vertebroplasty, symptomatic, vertebral, hemangiomas.