Kuppan Naveenkumar, Muthu Sathish, Krishnakumar R
Department of Orthopaedics and Spine surgery, Sree Manakula Vinayagar Medical College and Hospitals, Puducherry, India.
Department of Orthopaedics, Government Medical College, Dindigul, Tamil Nadu, India.
J Orthop Case Rep. 2022 Nov;12(11):95-99. doi: 10.13107/jocr.2022.v12.i11.3430.
Spinal hemangioma is the most common benign lesion of the spine with an incidence of 10-12%. Aggressive hemangioma presents with back pain, deformity, or neurologic deficit. Aggressive hemangioma presenting as painful scoliosis is very rare and literature reporting them is very limited.
We present the case of a boy in his second decade who presented with back pain for 1 month radiating to his right chest with a deformity in his back. MRI showed a hyperintense lesion involving the sixth dorsal vertebra in the T2-weighted image and a hypointense lesion with striations in STIR images suggestive of hemangioma. Pre-operative embolization was done using micro platinum coils. The patient underwent a decompressive laminectomy and vertebral body decompression. The patient also underwent 12 cycles of radiotherapy. The patient had complete resolution of the deformity without any recurrence at 2 years.
Management of aggressive hemangiomas with neurologic deficit needs a multidisciplinary approach with surgery, pre-operative embolization, and post-operative radiotherapy.
脊柱血管瘤是脊柱最常见的良性病变，发病率为10% - 12%。侵袭性血管瘤表现为背痛、畸形或神经功能缺损。表现为疼痛性脊柱侧凸的侵袭性血管瘤非常罕见，相关文献报道也非常有限。
我们报告一例十几岁的男孩，他背痛1个月，疼痛放射至右胸，背部有畸形。磁共振成像（MRI）显示在T2加权图像上第六胸椎有一个高信号病变，在短tau反转恢复（STIR）图像上有一个带条纹的低信号病变，提示为血管瘤。术前使用微铂金线圈进行了栓塞。患者接受了减压性椎板切除术和椎体减压术。患者还接受了12个周期的放射治疗。患者在2年时畸形完全消失，无任何复发。
伴有神经功能缺损的侵袭性血管瘤的治疗需要手术、术前栓塞和术后放疗的多学科方法。
