Hemangioma of the spine: symptoms and treatment, causes
Hemangioma of the spine is a spinal benign vascular tumor, created from an angiogenic mesoderm or mesenchyme, characterized by slow growth and arising from a disruption in the development of cavernous and capillary blood vessels.
Among all pathological formations of the spine, hemangioma occupies 2-3%.
For the first time a vascular neoplasm inside the vertebra was discovered by the German pathologist and physiologist Rudolf Virchow in 1863 when the body was opened. The disease occurs quite often, as a rule, in the adult population in the age range from 30-60 years.
What is it? The true cause of the appearance of the spinal hemangioma is unknown, despite the many studies carried out on this issue. The decisive factor may be a genetic predisposition. The initial damaging levers in the process of embryogenesis are oncogenes and teratogens, radiation, trauma, ischemia.
In women, this disease occurs more often than in the male population, which is associated with the circulation of estrogens. For a long time, the tumor can be asymptomatic.
Tumor process stimulates:
In many cases, the hemangioma of the spine does not manifest itself clinically and is detected accidentally. But sometimes the symptoms, nevertheless, are available and the most frequent of them is back pain, which is aggravated by movement and is the result of squeezing the spinal roots.
In 76% of cases, the spine is affected in the thoracic region, in the second place in the occurrence of a lumbar spine. It is characteristic that one vertebra is involved in the process, but localization can be multi-layered, which determines the nature and intensity of pain sensations.
Most hemangiomas do not increase in size, but in a number of episodes they can behave aggressively. In this case, clinical symptoms are characterized by fractures of the vertebrae even with a slight load. This is due to the inferiority of blood vessels, with a reduced density of bone tissue, loss of biomechanical density. As a result of injuries or other factors, minor bleeding occurs in the vertebrae. And blood, as is known, has the property to activate osteoclasts - cells that destroy bone tissue.
Aggressive hemangiomas manifest themselves as pain or neurologic symptoms that can be acute or increasing. Such neoplasms lead to a thinning of the cortical layer and spread to the whole body of the vertebra, the tumor can go into soft tissue. Due to compression of the area of the spinal cord, the development of paresis and paralysis, a sensitivity disorder.
The question of therapeutic tactics remains open for today. There is a thought that it is necessary to treat only symptomatic hemangiomas of the spine, while others require observation in dynamics.
The methods of treatment include:
It should be remembered that the hemangioma area( for large sizes) can not be massaged and heated, and manual and physiotherapy is contraindicated, since these actions contribute to the growth of the tumor and compression fractures.
A valuable diagnostic method is the radiography of the spine. Previously, a contrast medium is injected into the vessels of the tumor, which is visualized in the pictures and allows one to judge the size of the vessels, the blood flow velocity in them. But to distinguish aggressive hemangioma from non-aggressive by X-ray images before the development of compression fracture in most cases is impossible. In order to obtain accurate diagnostic data and determine indications for the treatment of the hemangioma of the spine, a combination of CT and MRI is used.
Among all pathological formations of the spine, hemangioma occupies 2-3%.
For the first time a vascular neoplasm inside the vertebra was discovered by the German pathologist and physiologist Rudolf Virchow in 1863 when the body was opened. The disease occurs quite often, as a rule, in the adult population in the age range from 30-60 years.
Causes of a hemangioma of the spine
What is it? The true cause of the appearance of the spinal hemangioma is unknown, despite the many studies carried out on this issue. The decisive factor may be a genetic predisposition. The initial damaging levers in the process of embryogenesis are oncogenes and teratogens, radiation, trauma, ischemia.
In women, this disease occurs more often than in the male population, which is associated with the circulation of estrogens. For a long time, the tumor can be asymptomatic.
Tumor process stimulates:
- injury;
- pregnancy( in the last third of the term);
- pressure on the affected vertebra;
- Osteoporosis in persons older than 40 years.
Symptoms of the hemangioma of the spine
In many cases, the hemangioma of the spine does not manifest itself clinically and is detected accidentally. But sometimes the symptoms, nevertheless, are available and the most frequent of them is back pain, which is aggravated by movement and is the result of squeezing the spinal roots.
In 76% of cases, the spine is affected in the thoracic region, in the second place in the occurrence of a lumbar spine. It is characteristic that one vertebra is involved in the process, but localization can be multi-layered, which determines the nature and intensity of pain sensations.
Most hemangiomas do not increase in size, but in a number of episodes they can behave aggressively. In this case, clinical symptoms are characterized by fractures of the vertebrae even with a slight load. This is due to the inferiority of blood vessels, with a reduced density of bone tissue, loss of biomechanical density. As a result of injuries or other factors, minor bleeding occurs in the vertebrae. And blood, as is known, has the property to activate osteoclasts - cells that destroy bone tissue.
Aggressive hemangiomas manifest themselves as pain or neurologic symptoms that can be acute or increasing. Such neoplasms lead to a thinning of the cortical layer and spread to the whole body of the vertebra, the tumor can go into soft tissue. Due to compression of the area of the spinal cord, the development of paresis and paralysis, a sensitivity disorder.
Treatment of hemangioma of the spine
The question of therapeutic tactics remains open for today. There is a thought that it is necessary to treat only symptomatic hemangiomas of the spine, while others require observation in dynamics.
The methods of treatment include:
- 1) Radiotherapy. The known method of treatment has been standard for many years. But at the present stage of the development of medicine, the use of rays is highly questionable due to numerous complications due to a large radiation load, low efficiency and a considerable number of contraindications.
- 2) Surgical removal. It is used for extravertebral expansion of the tumor with compression of the spinal cord, roots. Complete removal is not possible, since only the epidural part of the lesion is available for laminectomy. Open surgical intervention is used very rarely because of the heavy bleeding accompanying it, which makes it difficult to stabilize the operated segment of the spinal column.
- 3) Embolization of vessels feeding the tumor. In the vessels of the neoplasm, a special occlusion agent is introduced. The method has low efficiency, which is explained by frequent relapses of the disease. In addition, the procedure is technically difficult( in some cases impossible) and dangerous in terms of development of acute disorders of the spinal circulation.
- 4) Alcoholation of hemangioma. The first treatment with ethyl alcohol was carried out in 1994.In the process of vertebroplasty, up to 4 ml of alcohol is introduced into the hemangioma, which allows to minimize the volumes of the tumor due to the sclerosing effect. But such manipulations are dangerous with severe neurological complications( osteonecrosis, compression fractures).
- 5) Puncture vertebroplasty with polymethyl acrylate derivatives. The hemangioma is filled with radiocontrast bone cement after preliminary puncturing of the vertebral body. The method allowed to demonstrate a significant regression or subsidence of the pain syndrome during the first day after surgery and stop the growth of the tumor in the future. The plasticity of the vertebral body promotes the expansion of motor activity and reduces dependence on analgesics.
It should be remembered that the hemangioma area( for large sizes) can not be massaged and heated, and manual and physiotherapy is contraindicated, since these actions contribute to the growth of the tumor and compression fractures.
A valuable diagnostic method is the radiography of the spine. Previously, a contrast medium is injected into the vessels of the tumor, which is visualized in the pictures and allows one to judge the size of the vessels, the blood flow velocity in them. But to distinguish aggressive hemangioma from non-aggressive by X-ray images before the development of compression fracture in most cases is impossible. In order to obtain accurate diagnostic data and determine indications for the treatment of the hemangioma of the spine, a combination of CT and MRI is used.