University of Rochester School of Medicine, Rochester, New York.
Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
Spine (Phila Pa 1976). 2020 Jan 15;45(2):E99-E110. doi: 10.1097/BRS.0000000000003181.
Meta-analysis.
To understand the benefits and limitations of surgical management and adjuvant therapies for patients presenting with neurological deficits from vertebral hemangiomas (VH).
VH is the most common benign spine tumor but rarely causes symptoms. Patients with back pain alone are treated with conservative management (kyphoplasty and radiation therapy), while those with neurological deficits require complex multi-modal treatment plans.
A PubMed literature search for "symptomatic vertebral hemangioma with spinal cord compression" identified 47 articles. From these articles and their references, 19 observational studies on patients who underwent surgery for VH met inclusion criteria. Meta-analyses were performed comparing outcomes of the surgical and adjuvant therapies using Stata13 software. For those with insufficient data for meta-analyses, descriptive analyses of variables were completed.
One hundred ninety seven surgical cases of VH with neurologic deficits were identified. Surgery provided a complete remission of symptoms in 84% of patients, however 18% of patients had recurrence of hemangioma. Adjuvant interventions included radiation, embolization, and kyphoplasty. Radiation therapy (XRT) was associated with a lower recurrence rate and an increase in minor transient adverse effects. Preoperative embolization performed in 98 patients was associated with improved symptoms, reduced complications, lower recurrence rate, less blood loss, and higher incidence of pathologic vertebral fractures. Meta-analyses did not yield statistically significant results, likely due to the heterogeneity amongst the studies and small sample sizes, but the results compiled together provide insight on potential benefits of preoperative embolization for symptomatic relief and reduced risk of recurrence with XRT that deserves further study.
For patients with neurologic deficits from spinal cord or nerve root compression, surgery provides improvement in symptoms. Recurrence of VH and symptoms refractory to surgery can be further reduced by adjuvant therapies such as embolization, kyphoplasty, and radiation with some unique risks to each therapy.
荟萃分析。
了解手术治疗和辅助治疗对因椎体血管瘤（VH）引起神经功能缺损的患者的益处和局限性。
VH 是最常见的良性脊柱肿瘤，但很少引起症状。仅有背痛的患者接受保守治疗（球囊扩张椎体后凸成形术和放射治疗），而有神经功能缺损的患者需要复杂的多模式治疗方案。
通过 PubMed 文献检索“有脊髓压迫症状的症状性椎体血管瘤”，确定了 47 篇文章。从这些文章及其参考文献中，有 19 项关于接受 VH 手术治疗的患者的观察性研究符合纳入标准。使用 Stata13 软件对手术和辅助治疗的结果进行荟萃分析。对于那些数据不足无法进行荟萃分析的患者，完成了对变量的描述性分析。
共确定了 197 例有神经功能缺损的 VH 手术病例。手术使 84%的患者症状完全缓解，但有 18%的患者血管瘤复发。辅助干预措施包括放射治疗、栓塞和球囊扩张椎体后凸成形术。放射治疗（XRT）与较低的复发率和轻微的短暂不良反应增加相关。在 98 例患者中进行的术前栓塞与症状改善、并发症减少、复发率降低、出血量减少和病理性椎体骨折发生率升高相关。荟萃分析没有产生统计学上显著的结果，可能是由于研究之间存在异质性和样本量小，但综合结果提供了关于术前栓塞对症状缓解和 XRT 降低复发风险的潜在益处的见解，值得进一步研究。
对于因脊髓或神经根受压引起神经功能缺损的患者，手术可改善症状。通过辅助治疗，如栓塞、球囊扩张椎体后凸成形术和放射治疗，可以进一步降低 VH 的复发率和手术抵抗的症状，每种治疗方法都有其独特的风险。
2。
