Introduction: Vertebral hemangioma (VH) is the most common benign spine tumor but rarely causes symptoms. There has yet to be an extensive analysis of the reported surgical cases, intervention modalities, and corresponding outcomes. Patients with back pain alone are often treated with conservative management (kyphoplasty and radiation therapy), while those with neurological deficits require complex multi-modal treatment plans. This study is a meta-analysis on the surgical management and adjunctive therapies for patients presenting with neurological deficits from VH.
Methods: A PubMed literature search for “symptomatic vertebral hemangioma with spinal cord compression” identified 47 articles. From these articles and their references, 19 observational studies on patients who underwent surgery for VH met inclusion criteria. Meta-analyses were preformed comparing outcomes of the surgical and adjunctive therapies using SPSS 24.0 software. For those with insufficient data for meta-analyses, descriptive analyses of variables were completed.
Results: 197 surgical cases of VH with neurologic deficits were identified. The interventions identified included surgery (laminectomy and corpectomy, most commonly), radiation, embolization, and kyphoplasty. Surgery provided a complete remission of symptoms in 84% of patients, however 18% of patients had hemangioma recurrence. Of those with tumor recurrence or residual symptoms, those who had subsequent radiation had full remission of symptoms. Adjuvant radiation therapy was associated with a lower incidence of recurrence and a slight increase in minor transient adverse effects. Preoperative embolization was significantly associated with improved symptoms, in addition to having higher incidences of reduced complications, recurrence rate, and blood loss. However, embolization was also associated with pathologic vertebral fractures.
Conclusions: For patients with neurologic deficits from spinal cord or nerve root compression, surgery provides improvement in symptoms. Recurrence of VH and symptoms refractive to surgery can be further reduced by adjunctive therapies such as embolization, kyphoplasty, and radiation with some unique risks to each therapy.
Patient Care: This work can be used by clinicians to better understand the current peer-reviewed research on surgical management of vertebral hemangiomas with neurological deficits. When a patient presents with neurological deficits from vertebral hemangiomas, it often requires urgent decompression. In this case, a succinct summary of the adjunctive therapies and surgical approaches could be of use in clinical decision-making.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand the most studied surgical approaches and therapies for symptomatic vertebral hemangioma.
2) Understand advantages and disadvantages of the adjunctive therapies to surgery for vertebral hemangiomas.
3) Identify postoperative complications that are of concern in each adjunctive therapy.