The First Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Pain Physician. 2012 Jan-Feb;15(1):43-9.
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.
This study aimed to illustrate the validity of treatment with percutaneous vertebroplasty (PVP) in patients with symptomatic vertebral hemangiomas (VHs).
PVP in 26 patients with symptomatic VHs and its clinical effects were evaluated in 3-24 months follow-up.
An inteventional pain management practice, a medical center, major metropolitan city, China.
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.
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 follow-up 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).
An observational study with a relatively small sample size.
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.
椎体血管瘤是一种富血管的良性肿瘤。症状可能从单纯的椎体疼痛变化多样，有时对保守的医学治疗有抗性，发展为进行性神经功能缺损。手术或放射治疗多年来一直是首选的治疗方法，但由于术中与术后与这些病变的丰富血管相关的出血并发症，它们的效果变差了，这些病变通常在急性发作前进行术前栓塞。最近，一种经皮微创椎体成形术技术已被引入临床实践，作为有或无影像学侵袭性特征的症状性椎体血管瘤的传统手术和放射治疗的替代方法。
本研究旨在说明经皮椎体成形术（PVP）治疗有症状的椎体血管瘤（VH）的有效性。
在 3-24 个月的随访中，评估了 26 例有症状的 VH 患者接受 PVP 治疗及其临床效果。
中国一个大都市的介入疼痛管理实践、医疗中心。
对 26 例接受 PVP 治疗的患者进行了研究；共治疗了 28 个椎体。所有患者均随访 3-24 个月，平均随访 8.6 个月。在术前、术后和最终随访时，采用视觉模拟评分（VAS）和 36 项简短健康调查问卷（SF-36）评估临床疗效，比较治疗前后的影像学表现。
26 例患者（28 个椎体）均成功接受治疗，疼痛症状在 24 至 72 小时内得到满意缓解。水泥分布始终是弥漫和均匀的。我们发现 3 例存在椎旁水泥渗漏，但没有出现与硬膜外扩散相关的神经根症状。椎管和椎间孔内未见水泥渗漏。从未发生肺栓塞，也未观察到临床和症状性并发症。通过病理检查证实为血管瘤。VAS 评分从术前的 7.5 ± 1.5 分降至术后的 1.6 ± 0.6 分，最终评分为 0.7 ± 0.5。术后与术前、最终随访与术前比较，差异均有统计学意义（P < 0.05）。术后和最终随访时，患者的 SF-36 评分在身体角色、躯体疼痛、总体健康、活力、社会功能、情绪角色和精神健康方面均显著高于术前（P < 0.05）。
这是一项样本量相对较小的观察性研究。
PVP 是治疗症状性椎体血管瘤的有效方法，是一种有价值的、微创的、快速的方法，可以完全持久地缓解疼痛性椎体症状。
