Giorgi Pietro, Compagnone Domenico, Gallazzi Enrico, Schirò Giuseppe Rosario
Orthopaedic and Traumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
Residency Program in Orthopaedics and Traumatology, University of Milan, Milan, Italy.
J Craniovertebr Junction Spine. 2020 Apr-Jun;11(2):139-142. doi: 10.4103/jcvjs.JCVJS_31_20. Epub 2020 Jun 5.
Vertebral hemangiomas (VHs) are very common radiological findings, and the majority of them are completely asymptomatic and harmless. However, although rarely, they can present as locally aggressive, symptomatic lesions, and requiring surgery. In these cases, early diagnosis and treatment are mandatory to avoid serious complications and invasive surgery; however, there is no consensus about the best therapeutic option. Minimally-invasive percutaneous techniques have recently gained interests as a therapeutic option. A case of a 58-year-old male with a symptomatic aggressive VH of L5 presenting with untractable low back and radicular pain without neurological deficits is reported. An early percutaneous procedure with selective embolization combined with biportal kyphoplasty of L5 was performed. No complications and a very low-intraoperative bleeding were reported. The patient has been monitored for the following 5 years with a good outcome and with no signs of recurrence. This case report highlights the importance of making the right diagnosis and the advantages of an early percutaneous treatment with selective embolization and augmentation to avoid major open surgery with high risks.
椎体血管瘤（VHs）是非常常见的影像学表现，其中大多数完全无症状且无害。然而，尽管很少见，但它们可能表现为局部侵袭性、有症状的病变，需要手术治疗。在这些情况下，早期诊断和治疗是避免严重并发症和侵入性手术的必要条件；然而，对于最佳治疗方案尚无共识。近年来，微创经皮技术作为一种治疗选择受到了关注。本文报道了一例58岁男性，患有症状性侵袭性L5椎体血管瘤，表现为顽固性腰痛和神经根性疼痛，但无神经功能缺损。对其进行了早期经皮选择性栓塞联合L5双门椎体后凸成形术。未报告并发症，术中出血极少。对该患者进行了5年的随访，结果良好，无复发迹象。本病例报告强调了正确诊断的重要性，以及早期经皮选择性栓塞和强化治疗以避免高风险的大型开放手术的优势。
