A hemangioma is a common type of benign growth made up of a collection of small blood vessels. These vascular tumors can appear anywhere in the body, but when they occur in the vertebrae (bones of the spinal column), they are called vertebral or spinal hemangiomas. They are considered the most frequent type of benign tumor found in this location. While the presence of a spinal hemangioma usually does not lead to health problems, understanding its nature is important for those who receive this diagnosis.
Defining Spinal Hemangiomas
A spinal hemangioma represents an abnormal accumulation of blood vessels mixed with bone tissue inside the vertebral body. These lesions are typically slow-growing and are most often found in the thoracic (mid-back) and lumbar (lower-back) regions of the spine. As they are benign, they do not spread to other parts of the body, unlike malignant cancers.
Spinal hemangiomas are common, estimated to be present in up to 10-12% of the general population, yet most individuals never know they have one. They are frequently discovered incidentally during an imaging scan performed for an unrelated reason, such as a workup for back pain. The exact cause of these growths is not fully established, but it is believed they may form during embryonic development and become active later in life, sometimes influenced by hormonal changes.
These vascular lesions often affect the internal structure of the vertebra, replacing some of the normal bone marrow with blood vessels and fatty tissue. This change in composition can be visualized on medical imaging, giving the hemangioma a characteristic appearance. For instance, on a computed tomography (CT) scan, the remnants of the bone structure can present a distinct “polka-dot” or “corduroy” pattern, which helps medical professionals identify the lesion.
Recognizing Symptoms and Diagnostic Procedures
The vast majority of spinal hemangiomas are asymptomatic. In a small percentage of cases, the hemangioma may grow large or become aggressive enough to cause symptoms. When this occurs, the most common complaint is localized back pain, which can be mild to severe and sometimes worsened by movement. This pain results from the expansion of the lesion within the bone or from a resulting microfracture.
In rare instances, the growth may extend outside the vertebral body into the spinal canal. This expansion can lead to nerve compression, causing neurological symptoms such as numbness, tingling, or weakness in the arms or legs. More serious cases involve compression of the spinal cord itself, which may manifest as difficulty walking or a loss of bladder or bowel control.
The diagnosis often begins with a standard X-ray, which may reveal a distinctive lattice-like or striated pattern within the bone, suggesting the presence of a hemangioma. A CT scan is then frequently used to better visualize the bony structure and confirm the characteristic “polka-dot” appearance caused by the thickened bone trabeculae.
Magnetic resonance imaging (MRI) is considered the most effective tool for confirming the diagnosis and determining the extent of the lesion. An MRI provides detailed images of soft tissues, allowing doctors to assess the vascular nature of the growth and check for any extension into the spinal canal. This evaluation helps guide the decision for treatment, especially if the hemangioma is pressing on the spinal cord or nerve roots.
Treatment and Monitoring Strategies
For patients whose spinal hemangioma is found incidentally and causes no symptoms, no immediate treatment is typically necessary. The standard approach is “watchful waiting,” which involves periodic monitoring with follow-up imaging scans to ensure the lesion is not growing or becoming aggressive. This conservative strategy acknowledges the benign nature of the tumor and avoids unnecessary intervention.
Intervention is reserved for symptomatic hemangiomas, particularly those causing pain, rapid growth, or neurological deficits due to spinal cord or nerve compression. Treatment aims to reduce the size of the growth, stabilize the weakened vertebra, and alleviate pressure on the nervous system. Minimally invasive procedures are often the first line of treatment for painful lesions without nerve involvement.
One procedure is vertebroplasty or kyphoplasty, where bone cement is injected into the affected vertebral body to stabilize the bone and provide immediate pain relief. For highly vascular hemangiomas causing symptoms, transarterial embolization may be performed to block the blood supply to the tumor, shrinking it and reducing the risk of bleeding during subsequent procedures. Radiation therapy is another option used to shrink the hemangioma, particularly if it is causing pain and other treatments are not suitable.
In the rare circumstance of severe spinal cord compression or progressive neurological decline, surgical removal of the portion of the vertebra containing the hemangioma may be required. This surgery is often preceded by embolization to minimize blood loss, followed by spinal stabilization. The choice of treatment is individualized, depending on the patient’s symptoms, the size of the lesion, and whether it has compromised the integrity of the spine.