K Guna Pratheep, Shetty Ajoy Prasad, K S Sri Vijay Anand, Kavishwar Rohit, Kanna Rishi Mugesh, Rajasekaran Shanmuganathan
Department of Spine Surgery, Ganga Medical Centre and Hospitals, Coimbatore, India.
Asian Spine J. 2023 Feb;17(1):37-46. doi: 10.31616/asj.2021.0481. Epub 2022 Aug 23.
This was a retrospective study.
To analyze the surgical and neurological outcomes following surgical decompression in patients with aggressive vertebral hemangioma (AVH) presenting with neurological deficit and to determine whether a less extensive approach is appropriate.
AVHs are a rare subset of benign vascular tumors frequently presenting with neurological deficit because of spinal cord compression. Though the results of surgical management have improved over time, there is a lack of consensus on the ideal management in this group of patients.
Twenty-one patients who underwent surgery for AVH between 2009 and 2018 were analyzed. Demographic and clinical details of patients were retrieved from hospital information system. Imaging information (i.e., radiography, computed tomography, magnetic resonance imaging) of all patients was accessed and analyzed in picture archiving and communication system. Tumor staging was performed using Enneking and Weinstein-Boriani-Biagini classifications and Spinal Instability Neoplastic Score. At followup, neurological and radiological evaluations were performed.
Twenty-one patients (13 [61.9%] females and 8 [38.1%] males) were included with a mean age of 44.29 years (range, 14-72 years). All patients in the study had neurological deficit. Back pain was present in 80.9% of patients. Mean duration of symptoms was 4.6 months (range, 1 day to 10 months). Most common lesion location was thoracic spine (n=12), followed by thoracolumbar (D11- L2; n=7) and lumbar (n=2) regions. Ten patients had multiple level lesions. All patients underwent preoperative embolization. Nine patients underwent intralesional spondylectomy with reconstruction; another nine patients underwent stabilization, decompression, and vertebroplasty; three patients underwent decompression and stabilization. Neurology improved in all patients, and only one case of recurrence was noted in a mean follow-up of 55.78±25 months (range, 24-96 months).
In AVH, good clinical and neurological outcomes with low recurrence rates can be achieved using less extensive procedures, such as posterior instrumented decompression with vertebroplasty and intralesional tumor resection.
这是一项回顾性研究。
分析患有神经功能缺损的侵袭性椎体血管瘤（AVH）患者手术减压后的手术及神经学结果，并确定采用范围较小的手术方法是否合适。
AVH是良性血管肿瘤的一个罕见亚型，常因脊髓受压而出现神经功能缺损。尽管随着时间推移手术治疗的结果有所改善，但对于这组患者的理想治疗方法仍缺乏共识。
对2009年至2018年间接受AVH手术的21例患者进行分析。从医院信息系统中获取患者的人口统计学和临床详细信息。在图像存档与通信系统中访问并分析所有患者的影像学信息（即X线摄影、计算机断层扫描、磁共振成像）。使用Enneking和Weinstein-Boriani-Biagini分类法以及脊柱不稳定肿瘤评分进行肿瘤分期。在随访时，进行神经学和影像学评估。
纳入21例患者（13例[61.9%]女性和8例[38.1%]男性），平均年龄44.29岁（范围14 - 72岁）。研究中的所有患者均有神经功能缺损。80.9%的患者存在背痛。症状平均持续时间为4.6个月（范围1天至10个月）。最常见的病变部位是胸椎（n = 12），其次是胸腰段（D11 - L2；n = 7）和腰椎（n = 2）区域。10例患者有多个节段病变。所有患者均接受了术前栓塞。9例患者接受了病灶内椎体次全切除术并重建；另外9例患者接受了稳定、减压和椎体成形术；3例患者接受了减压和稳定手术。所有患者的神经功能均有改善，在平均55.78±25个月（范围24 - 96个月）的随访中仅发现1例复发。
在AVH中，采用范围较小的手术方法，如后路器械辅助减压联合椎体成形术和病灶内肿瘤切除术，可取得良好的临床和神经学结果，且复发率低。
