Bourghli Anouar, Abduljawad Salim M, BoissiÈre Louis, Khalifa Hani, Obeid Ibrahim
Orthopaedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia.
Orthopaedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital, Bordeaux, France.
Int J Spine Surg. 2020 Jun 30;14(3):418-425. doi: 10.14444/7055. eCollection 2020 Jun.
Aggressive vertebral hemangioma is rare, and its management can be very challenging.
In this report, we present the case of a 30-year-old female with a normal twin pregnancy. She had been complaining of midthoracic pain after the seventh month of pregnancy with no other symptoms. Normal delivery was done under spinal anesthesia, but the patient's back pain worsened after the delivery, and she left the hospital on Day 4 with the onset of an unsteady gait. She was seen in the spinal clinic on Day 14, referred by her gynecologist, with a paraparetic presentation that was rapidly worsening. Urgent magnetic resonance imaging (MRI) was done and revealed aggressive hemangioma of T6 with kyphosis and significant cord compression.
The patient was admitted and was operated the following morning. Posterior decompression with fixation from T4 to T8 and kyphosis correction was done. Samples from the vertebrae were sent to the lab for pathology analysis, and the results confirmed the diagnosis of vertebral hemangioma. She could walk on Day 1 with progressive neurological recovery, but distal junctional kyphosis in the form of a "chance fracture" of T8 occurred at 2 months and was treated conservatively. She showed a satisfactory clinical and radiological result at 2 years with no recurrence.
Literature is sparse on the management of vertebral hemangioma in the context of pregnancy and postpartum, with only case reports, and its presentation as a kyphotic fracture is extremely rare. The current case shows how, in the context of delivery, a benign procedure such as spinal anesthesia should be done with extreme caution, as it may play a role in aggravating an undiagnosed aggressive hemangioma; rapid management after the onset of paraparetic symptoms enables a full neurological recovery, but close monitoring later on with regular MRI is mandatory for detection of any recurrence.
侵袭性椎体血管瘤罕见，其治疗极具挑战性。
在本报告中，我们介绍了一名30岁双胎妊娠且身体状况正常的女性病例。她在怀孕7个月后开始抱怨胸中部疼痛，无其他症状。在脊髓麻醉下进行了顺产，但产后患者背痛加重，第4天出院时出现步态不稳。第14天，她经妇科医生转诊至脊柱门诊，表现为双下肢轻瘫且病情迅速恶化。紧急进行了磁共振成像（MRI）检查，结果显示T6椎体侵袭性血管瘤伴脊柱后凸和明显的脊髓受压。
患者入院，次日上午接受手术。进行了T4至T8节段的后路减压固定及脊柱后凸矫正。取自椎体的样本送实验室进行病理分析，结果确诊为椎体血管瘤。术后第1天她就能行走，神经功能逐渐恢复，但2个月时出现了T8椎体“偶然性骨折”形式的远端交界性后凸，采取了保守治疗。2年后，她的临床和影像学结果均令人满意，无复发。
关于妊娠和产后椎体血管瘤治疗的文献稀少，仅有病例报告，且其表现为脊柱后凸骨折极为罕见。本例表明，在分娩过程中，应极其谨慎地进行脊髓麻醉等良性操作，因为这可能会加重未被诊断出的侵袭性血管瘤；双下肢轻瘫症状出现后迅速治疗可实现神经功能完全恢复，但后续必须定期进行MRI密切监测以检测任何复发情况。
