Spinal hemangioma: causes and treatment

16 June 2020

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Hemangiomas are vascular tumors that can occur in the skin and any internal organs that contain a network of blood vessels. Thus, such formations cannot form only in the articular surfaces and optically transparent environments of the eyes. The spine is one of the places where it can form. In such cases, a hemangioma of the spine, or more correctly, a vertebra, is diagnosed.

A tumor of this kind in 100% of cases is a benign neoplasm and never becomes malignant, i.e., does not turn into malignant. Vertebral hemangioma is localized in its thickness, which is due to the peculiarities of the blood supply to the structural elements of the spine, and is, so to speak, an advantageous location for a tumor of this type. Growing inside the spongy tissue of the vertebra, the vascular formation is reliably protected from external influences by the bone, which reduces the risk of injury to a minimum. At the same time, hemangiomas formed in the parenchyma of internal organs are easily damaged and can become a source of severe bleeding.

In recent years, the frequency of diagnosing vertebral hemangiomas has increased significantly, but not due to an increase in the number of cases of their formation, but due to the introduction of modern diagnostic methods: CT and MRI.

How dangerous is the disease?

A small hemangioma does not pose any danger. Such a benign tumor rarely manifests itself. About 10% of patients do not even suspect its presence. If the tumor is less than 1 centimeter, then it is only observed; if it begins to grow, it is removed.

Developing between the vertebrae, the tumor can invade several neighboring vertebrae, usually 2-3 vertebrae. Large tumors cause pain and can also cause vertebral collapse. In this case, compression of the nerve endings of the spine occurs, which leads to both pain and numbness in this area of ​​the back. In addition, a vertebral hemangioma of significant size can cause its fracture.

A large tumor in the lumbar spine can cause:

• urinary disturbance;
• problems with bowel movements;
• numbness of limbs and so on.

How to diagnose

Typically, the diagnosis is made after signs of the disease appear. For this, the following diagnostic methods are used:

1. X-ray is the most cost-effective examination option, but does not convey a complete picture of the condition of the thoracic spine.
2. CT - compared to radiography, is a more informative way to diagnose hemangiomas. It combines X-ray scanning and processing of the resulting images using a special program.
3. MRI is the most effective method for examining the spine and identifying benign tumors. Allows you to determine their size, structure, location, etc.

Causes of hemangioma

Spinal hemangioma occurs when improper (chaotic) division of vascular tissue cells occurs. What this depends on is still a matter of debate in scientific circles. However, it has been noted that the main factor in most cases is heredity. Studies have shown that such a tumor can also occur with increased levels of estrogen, so it is most often found in women. The disease also occurs when there is heavy load on the spine, for example, during pregnancy or when lifting heavy objects.

Tests and diagnostics

What is spinal ependymoma?

Vertebral hemangioma is usually diagnosed using MRI (magnetic resonance imaging) and CT (computed tomography).

MRI machines use magnets and radio waves to produce images of organs and tissues such as the brain and spinal cord. A CT scan uses a combination of X-rays and computer technology to produce detailed images of bones and soft tissue.

The vascular nature of the tumor allows the use of contrast agents during examination. They are injected into the bloodstream and help highlight tumor tissue in an image of the spine. Contrast is used to distinguish hemangiomas from other tumors, for example, osteomas or osteosarcomas, metastases.

If an MRI shows a hemangioma requiring surgery, then additional studies of its blood supply are performed. For this purpose, the angiography method is used. A dye is injected into the vessels, and then the blood supply network and the structure of the tumor vessels are determined using x-rays.

It is important that such a study also allows you to monitor the progress of the operation for hemangioma. It involves cutting off the blood flow to the tumor to cause it to grow back or die. For this purpose, the doctor can inject a special drug into the feeding vessel, causing inflammation of the walls and its overgrowth with connective tissue (sclerotherapy method), or he can use a special “plug” - a blood clot (embolization) or drugs that cause hardening of the vessels (vertebroplasty).

The cessation of blood supply to the tumor will be clearly visible on the angiogram.

Types of tumors

There are two types of hemangiomas:

• non-aggressive - the tumor behaves calmly, it is discovered by chance during a medical examination or after a computed tomography);
• aggressive - the tumor grows quickly and causes severe pain during movement).

Based on their structure, hemangiomas are divided into the following types:

• capillary (vascular);
• cavernous;
• mixed (vascular-cavernous).

In most cases, spinal hemangioma is a non-aggressive tumor that does not pose any threat. But in exceptional cases, the disease destroys bone tissue.

By location

Depending on the location of occurrence, hemangiomas of the cervical, thoracic and lumbar spine are distinguished.

Cervical hemangioma

A tumor of this localization causes headaches and frequent dizziness. Vision may be impaired, and insomnia is a common symptom. This is affected by compression of the artery and poor circulation.

Hemangioma of the thoracic region

The initial stages of the disease are asymptomatic. Typically, such a tumor grows very slowly. When a hemangioma in the thoracic spine grows to a size of more than 1 cm, it begins to compress the vertebrae. At first, the pain occurs periodically, but over time it becomes constant. This all happens due to compression of the nerve endings. Symptoms and treatment of hemangioma of the thoracic spine differ from the symptoms, as well as methods of conservative treatment of a tumor located in the cervical spine.

Hemangioma of the thoracic spine causes:

• numbness of hands and feet;
• gastrointestinal problems;
• constant weakness;
• pain in the spine;
• heart rhythm disturbance;
• infertility in women.

In this regard, cardiological drugs are used along with conventional conservative treatment methods. It is also recommended to consult a gastroenterologist and gynecologist in case of illness.

Lumbar hemangioma

Appearing in the lumbar spine, hemangioma disrupts the functioning of the pelvic organs. Symptoms usually become noticeable when the tumor is already quite large. Thus, a tumor measuring 1 cm or more can cause:

• numbness of the limbs;
• lower back pain;
• the appearance of problems with urination;
• fecal incontinence.

In count

In one patient, one to several formations may occur simultaneously. After making an appointment with a doctor, the patient will be told the exact number of formations.

Single

Single hemangiomas are most common. They can be localized in any part of the spine.

Multiple

The rarest and most dangerous type is multiple hemangiomas. They can be located in different parts of the spine at once, which aggravates the patient’s condition.

By content

Based on their contents, spinal hemangiomas are divided into the following types:

• vascular;
• cavernous;
• mixed.

Vascular

Vascular neoplasms consist of several fused thin-walled vessels, between which fibrous or adipose tissue accumulates.

Cavernous

They consist of several thin-walled vessels that communicate with each other.

Vascular-cavernous

A mixed (vascular-cavernous) benign tumor consists of blood vessels, as well as vascular cavities.

Choosing the optimal treatment method

When choosing a technology for treating hemangioma in the neck, not a single doctor in the neurosurgery department of the City Clinical Hospital named after. Yeramishantseva will not guess from the tea leaves. Here, diagnostic data and accurate information on the location of the tumor and its size, the degree of damage to the vertebrae of the cervical spine, and the level of tumor spread to surrounding tissues are important.

Modern medicine offers a fairly large number of methods for treating hemangioma. Regardless of the option chosen, an additional measure is often prescribed - drug treatment. It is aimed at eliminating swelling of the problem area and relieving pain. So, how to get rid of hemangioma?

RADIATION THERAPY. This method is used extremely rarely, as it has a whole range of disadvantages: radiation exposure, local skin reactions, compression of nerve roots, risk of damage to the integrity of the vertebral body, and other complications. Not recommended for children, pregnant women and women during breastfeeding. Radiation therapy has long faded into the background.

ALCOHOLIZATION. This is a procedure for introducing an alcohol solution into the vessels of the neoplasm to harden them. As a result, the size of the tumor decreases, but the positive effect is accompanied by such negative phenomena as thinning of bone tissue and complications aimed at the spinal column. This method is more suitable for treating hemangioma with a different location.

VASCULAR EMBOLIZATION. Filling with a medicinal solution either the neoplasm itself or the vessels closest to it. The procedure requires minimal surgery, but has some pitfalls. For example, there is a high percentage of relapses, possible circulatory disorders in the structures and tissues of the spinal cord, and sensitivity disorders of the skin in the problem area.

PUNCTURE VERTEBROPlasty. This involves introducing a special cementing mixture with titanium and a contrast agent into the problem vertebra. Most often used for aggressive development of the disease. The main advantages of this method are stabilization of the vertebral body and tumor reduction. Percutaneous vertebroplasty can be combined with other treatment methods.

OPEN OPERATION. The specialist uses a small incision to access the cervical spine and surgically remove the benign tumor. This method is especially relevant when diagnosing pinched nerve roots. The disadvantage of the operation is the long rehabilitation period (the exact period is determined individually). During the recovery stage, excessive physical activity, visiting the sauna, and taking immunostimulating drugs are prohibited.

Symptoms and signs

The symptoms of the disease depend on the size of the tumor and where it is located:

• a tumor less than 1 cm may not bother you, but sometimes causes periodic back pain;
• a tumor that has grown to a size of more than 1 cm causes severe, constant back pain.

Spinal hemangioma is a benign formation that can destroy the structure of the vertebrae. As the tumor body grows, the vertebrae can be compressed and cause disruption of the intestines and bladder, causing numbness in the arms and legs.

Treatment of hemangioma

Only a doctor determines the diagnosis, stage of the disease and prescribes treatment for spinal hemangioma. So, the treatment process can be:

• medicinal (conservative);
• operational;
• special.

Treatment is prescribed after all necessary measures and examinations. If the tumor is small and non-aggressive, then it is observed and conservative treatment is applied. If the tumor begins to bother you and its size increases, then it is operated on or special treatment methods are used (X-ray irradiation, embolization, etc.)

Drug treatment

With drug treatment, the tumor will not disappear. This treatment is aimed at reducing pain and unpleasant symptoms.

The following drugs are usually used:

• painkillers, analgesics;
• anti-inflammatory non-steroidal drugs;
• vitamin complexes;
• hormonal drugs;
• various muscle relaxants.

Surgical intervention

If a hemangioma occurs on the spine, is surgery necessary? The main thing in treating such a disease is to do no harm. Surgical intervention is prescribed only when conservative treatment does not improve the condition, and the tumor grows rapidly, hurts unbearably and poses a threat to the entire body.

Massage and physiotherapy

In case of spinal hemangioma, any physiotherapy and massage are strictly prohibited. Various rubbing with warming ointments, compresses, etc. are prohibited, as these methods can provoke a sharp growth of the tumor.

Traditional methods

It is believed that treatment with traditional methods for spinal hemangioma is absolutely ineffective and useless. Traditional medicine will not relieve pain or reduce swelling. In addition, such interference can only cause harm.

Rehabilitation and recovery prognosis

It should be immediately noted that the speed of recovery, as well as the prognosis of recovery, largely depend on the specific treatment method.

For example, if the tumor was removed through surgery, the patient will have to undergo long-term rehabilitation. Sometimes a stay in the hospital can last for several months. In this case, there is a high probability of relapse.

At the same time, if vertebroplasty was chosen to combat spinal hemangioma, then in this case the patient can be released from the hospital within a few hours. Moreover, after vertebroplasty the disease does not appear even after many years.

Preventive measures

Having learned what spinal hemangioma is, you can now prevent the development of complications. Preventive measures will prevent the disease from starting and not worsening the condition. It is necessary to see a doctor annually and monitor tumor growth. Benign neoplasms react very poorly to sunlight. With this disease, it is recommended to avoid solariums, long stays on the beach, avoid engaging in traumatic sports, and stop using immunostimulants.

Important requirements for disease prevention

Particular attention to preventive recommendations should be paid to those people who have a genetic predisposition to hemangioma in the neck. Important rules:

• refusal of physical activity and strength sports, which can cause injury not only to the cervical spine, but also to the entire spine;
• adherence to a diet developed by professional nutritionists (for example, consuming increased amounts of protein);
• any thermal and physiological procedures are undesirable, because most of them lead to accelerated tumor growth;
• Regular visits to the doctor and, if necessary, undergoing a special diagnostic examination.

IMPORTANT! It is recommended to undergo examinations with a doctor at least once a year. The best option is to sign up for a consultation every six months. This approach will make it possible to identify pathological processes at an early stage of their development.