Minim Invasive Neurosurg 2010; 53(5/06): 275-278
DOI: 10.1055/s-0030-1267925
Case Report

© Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive Decompression and Stabilisation for Extensive Haemangiomas of Lumbar Spine

K. K. Gnanalingham1 , M. B. Afridi1 , A. Abou-Zeid1 , A. Herwadkar2
  • 1Department of Neurosurgery, Greater Manchester Neurosciences Centre, Salford Royal Foundation Trust (SRFT), Manchester, UK
  • 2Department of Neuroradiology, Greater Manchester Neurosciences Centre, Salford Royal Foundation Trust (SRFT), Manchester, UK
Further Information

Publication History

Publication Date:
07 February 2011 (online)

Abstract

Introduction: Vertebral haemangiomas are a common incidental finding and are largely asymptomatic. Extensive haemangiomas of the spine causing neurological deficits are exceedingly rare. Traditional open surgical approaches in these cases can be complicated by life-threatening blood loss.

Patient Case History: We describe 2 patients (ages 27 and 53 years) who presented with severe back pain and lower limb weakness. Radiological investigations revealed very extensive lesions of the L1 and L4 vertebral bodies, respectively, with severe narrowing of the lumbar canal. After selective embolisation of the spinal arterial feeders, both patients underwent a posterior decompression, vertebroplasty, and bilateral pedicle screw fixation in a minimally invasive fashion. Blood loss was minimal and a rapid clinical recovery was seen.

Conclusions: Combinations of embolisation, vertebroplasty and minimally invasive posterolateral instrumentation are treatment strategies that can be used to treat extensive vertebral haemangiomas presenting with neurological deficits.

References

  • 1 Acosta FL, Dowd CF, Chin C. et al . Current treatment strategies and outcomes in the management of symptomatic vertebral haemangiomas.  Neurosurgery. 2006;  58 287-295
  • 2 Blankstein A, Spiegelmann R, Shacked I. et al . Hemangioma of the thoracic spine involving multiple adjacent levels: case report.  Paraplegia. 1988;  26 186-191
  • 3 Dagi TF, Schmidek HH. Vascular tumours of the spine, in Sundaresan N, Schmidek HH, Schiller AL, Rosenthal DI (eds): Tumours of the Spine: Diagnosis and Clinical Management.. Philadelphia, W.B. Saunders Co; 1990: 181-191
  • 4 Fox MW, Onofrio BM. The natural history and management of symptomatic and asymptomatic vertebral haemangiomas.  J Neurosurg. 1993;  78 36-45
  • 5 Healy M, Herz DA, Pearl L. Spinal hemangiomas.  Neurosurgery. 1983;  13 689-691
  • 6 Krueger EG, Sobel GL, Weinstein C. Vertebral haemangioma with compression of spinal cord.  J Neurosurg. 1961;  18 331-338
  • 7 Nguyen JP, Djindjian M, Gaston A. Vertebral haemangiomas presenting with neurologic symptoms.  Surg Neurol. 1987;  27 391-397
  • 8 Murugan L, Samson RS, Chandy MJ. Management of symptomatic vertebral haemangiomas: Review of 13 patients.  Neurol India. 2002;  50 300-305
  • 9 Nguyen JP, Djindjian M, Pavlovitch JM. et al . Vertebral haemangioma with neurologic signs. Therapeutic results. Survey of the French Society of Neurosurgery.  Neurochirurgie. 1989;  35 299-303
  • 10 Feuerman T, Dwan PS, Young RF. Vertebrectomy for treatment of vertebral haemangioma without preoperative embolisation. Case report.  J Neurosurg. 1986;  65 404-406
  • 11 Nassar SI, Hanbali FS, Haddad MC. et al . Thoracic vertebral haemangioma with extradural extension and spinal cord compression. Case report.  Clin Imaging. 1998;  22 65-68
  • 12 Ogura T, Mori M, Hayashida T. et al . Spinal reconstruction for symptomatic thoracic haemangioma using a titanium cage.  Postgrad Med J. 2002;  78 559-561
  • 13 Datta G, Gnanalingham KK, Peterson D. et al . Back pain and disability following lumbar laminectomy – Is there a relationship to muscle retraction?.  Neurosurgery. 2004;  54 1413-1420
  • 14 Kawaguchi Y, Matsui H, Tsuji H. Back muscle injury after posterior lumbar surgery. Part 2: Histological and histochemical analyses in humans.  Spine. 1994;  19 2598-2602
  • 15 Styf J, Willen J. The effects of external compression by 3 different retractors on pressure in the erector spine muscles during and after posterior lumbar spine surgery in humans.  Spine. 1998;  23 354-358
  • 16 Anderson DG, Samartzis D, Shen FH. et al . Percutaneous instrumentation of the thoracic and lumbar spine.  Orthop Clin N Am. 2007;  38 401-408
  • 17 Foley KT, Gupta SK. Percutaneous pedicle screw fixation of the lumbar spine: preliminary clinical results.  J Neurosurg. 2002;  97 7
  • 18 Foley KT, Gupta SK, Justis JR. et al . Percutaneous pedicle screw fixation of the lumbar spine.  Neurosurg Focus. 2001;  10 E10
  • 19 Kim D-Y, Lee S-H, Chung SK. et al . Comparison of multifidus muscle atrophy and trunk extension muscle strength.  Spine. 2004;  30 123-129
  • 20 Kim K-T, Lee S-H, Suk K-S. et al . The quantitative analysis of tissue injury markers after mini-open lumbar fusion.  Spine. 2006;  31 712-716

Correspondence

K. K. Gnanalingham

Department of Neurosurgery

Greater Manchester Neurosciences

Centre

Salford Royal Foundation Trust

(SRFT)

Stott Lane

Salford M6 8HD

United Kingdom

Phone: +44/161/206 4340

Fax: +44/161/206 4606

Email: kanna.gnanalingham@srft.nhs.uk

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