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Aggressive Vertebral Hemangioma Causing Acute Spinal Cord Compression
Sokol Trungu, MD Via Pio X 4 Tricase, Italy s_trungu@hotmail.com
This article was originally published by Thieme Medical and Scientific Publishers and was migrated to Scientific Scholar after the change of Publisher.
A 46-year-old woman presented to our emergency department with sudden onset of lower extremity weakness after physical activity. She referred only dorsal back pain before these symptoms. Neurologic examination revealed weakness 2/5 of lower limbs, hyperreflexia of deep tendon reflex of lower limbs, hypoesthesia under D7 level, and no sphincteric dysfunction. A computed tomography scan showed an accentuation of trabecular markings within the vertebral body and areas of lysis (Figs. 1A F). Contrast-enhanced magnetic resonance images show diffuse abnormal marrow signal throughout the T6 vertebral body with epidural components with spinal cord compression (Fig. 1B H).
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Fig. 1 Sagittal (A) and axial (F) computed tomography images demonstrating accentuation of trabecular markings within the vertebral body and areas of lysis involving the entire T6 vertebral body. Sagittal T1-weighted (B); sagittal (C) and axial (G) T2-weighted; sagittal (D), coronal (E), and axial (H) contrast-enhanced magnetic resonance images showing a T6 aggressive hemangioma with epidural extension and severe anterior cord compression.
Fig. 1 Sagittal (A) and axial (F) computed tomography images demonstrating accentuation of trabecular markings within the vertebral body and areas of lysis involving the entire T6 vertebral body. Sagittal T1-weighted (B); sagittal (C) and axial (G) T2-weighted; sagittal (D), coronal (E), and axial (H) contrast-enhanced magnetic resonance images showing a T6 aggressive hemangioma with epidural extension and severe anterior cord compression.
She underwent surgery on the same day through a mini-open decompression and percutaneous short posterior fixation (Fig. 2). No complications occurred after surgery with full recovery of neurological symptoms. Radiotherapy was perfomed after 4 weeks with resolution of dorsal back pain.
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Fig. 2 Sagittal (A) and axial (B-D) postoperative computed tomography images demonstrating the posterior decompression and short pedicle screw fixation.
Fig. 2 Sagittal (A) and axial (B-D) postoperative computed tomography images demonstrating the posterior decompression and short pedicle screw fixation.
Vertebral hemangiomas (VH) are benign and generally asymptomatic primary vascular tumors of bone.1 2 Rarely, these lesions can cause symptoms due to cord compression as a result of bone expansion, erosion through cortex, fracture, or hematoma.3 Despite our long-standing recognition of aggressive VH, there is still a controversy regarding the optimal treatment strategy, and numerous therapeutic options have been described: embolization, surgery, radiotherapy, vertebroplasty, or a combination of them.4 5 6 7 8 9
Conflict of Interest
None declared.
Funding None.
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