Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, United States.
Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, IA, 52242, USA.
Clin Neurol Neurosurg. 2020 Mar;190:105745. doi: 10.1016/j.clineuro.2020.105745. Epub 2020 Feb 19.
Vertebral hemangiomas (VH) are common benign lesions involving the spine. Owing to the multiplicity of treatments, the management of VH has not always been consistent. In this retrospective review of a single center experience, indications and options available for the treatment of VH are outlined.
This is a retrospective review of 71 cases of VH managed at our institution between 2005 and 2019. Sixty of these cases were managed non-operatively, with 11 cases undergoing operative intervention. Of the 11 cases that underwent surgery, there were 2 cervical cases and 9 in the thoracic spine. Ten cases were symptomatic, and 1 incidental. Three patients presented with localized pain, and the remaining 7 had neurological deficit. Decompression with maximal resection of the hemangioma was undertaken in 10 cases, and vertebroplasty in 1.
Of the 60 patients who were managed non-operatively, 13 patients had presented with back/neck pain, with the remaining 47 patients being asymptomatic and diagnosed incidentally. Among the 13 symptomatic patients, all were offered surgical intervention for pain management, but given lack of severity of symptoms, all had opted for conservative approaches of pain control. In the 11 patients who underwent surgery, the preoperative diagnosis of VH was accurate in all but 1 case. There were 2 cervical cases treated with corpectomy. One patient was treated with vertebroplasty, and the remaining 8 with decompression. Radiation was used in 2 cases. Of the 10 patients undergoing decompression, 7 patients had improvement of the neurologic deficit, with resolution of pain in the remaining 3. None of our cases demonstrated deterioration.
VH are often discovered incidentally during evaluation of spinal pain. Except in rare cases, the diagnosis of VH is made correctly from the radiographic and MRI studies. Observation for the asymptomatic lesion is appropriate. For VH presenting with deficit or intractable pain, decompressive surgery is recommended. Radiation is appropriate in cases of recurrent VH.
椎体血管瘤（VH）是一种常见的脊柱良性病变。由于治疗方法多样，VH 的治疗方法并不总是一致的。在对单一中心经验的回顾性研究中，概述了 VH 的治疗指征和可用选择。
这是对 2005 年至 2019 年期间在我们机构接受治疗的 71 例 VH 患者的回顾性分析。其中 60 例患者接受非手术治疗，11 例患者接受手术干预。在接受手术的 11 例患者中，有 2 例颈椎病例和 9 例胸椎病例。10 例有症状，1 例为偶发病例。3 例患者表现为局部疼痛，其余 7 例有神经功能缺损。10 例患者行减压并最大限度切除血管瘤，1 例行椎体成形术。
在 60 例接受非手术治疗的患者中，有 13 例患者出现背痛/颈痛，其余 47 例患者无症状，为偶然诊断。在 13 例有症状的患者中，所有患者均因疼痛管理而接受手术干预，但由于症状严重程度较轻，所有患者均选择了保守的疼痛控制方法。在接受手术治疗的 11 例患者中，除 1 例外，所有患者术前诊断为 VH 均准确。有 2 例颈椎病例采用椎体切除术治疗。1 例患者接受椎体成形术，其余 8 例接受减压术。2 例患者接受了放疗。在接受减压术的 10 例患者中，7 例患者的神经功能缺损得到改善，其余 3 例患者的疼痛得到缓解。我们的病例均无恶化。
VH 通常在评估脊柱疼痛时偶然发现。除少数情况外，VH 的诊断可通过影像学和 MRI 研究正确做出。对于无症状病变，观察是合适的。对于有神经功能缺损或顽固性疼痛的 VH，建议行减压手术。对于复发性 VH，放疗是合适的。
