Most hemangiomas are casual findings when performing an imaging test such as magnetic resonance imaging.
What Is A Hemangioma Of The Spine?
The vertebral hemangioma is a vascular structure (formed by tissue from blood vessels) that is located inside the vertebra due to an error in embryonic development.1 Although they are spoken of as benign tumors, they are really a malformation of the vascular structure. The injury occupies a space in which there should be bone.
There are many types of hemangiomas. A hemangioma of the spine is a benign tumor that is usually found in the mid-back (thoracic) and the lower back (lumbar). These can originate pain in the area or they can be asymptomatic, which means they do not produce any symptom.
What Symptoms Produce A Hemangioma?
In the vast majority of hemangioma cases, there is no symptom. As aforementioned, they are seen when evaluating the spine on x-ray, magnetic resonance or other tests. The hemangiomas that can concern doctors are those that produce pain or neurological symptoms or those that are at risk of doing so.
Sometimes there may be doubts as to whether the angioma is causing pain, as it is often accompanied by arthritic signs and disc injuries, for example. For this reason, if the angioma is limited to the vertebral body and is in the cervical or lumbar area, it is likely that they will not evolve and doctors assume that they are not dangerous.
Hemangiomas that show no symptoms are usually found in the lumbar or dorsal area and are limited to being contained in the vertebral body.
It must be made clear that angiomas rarely cause problems. It is exceptional to see a vertebral fracture due to a hemangioma. The problem can come when these lesions grow, expand and cause damage to the structures that surround them. We must remember that the vertebrae surround the spinal cord, which is the structure that contains the nerves that descend from the brain to distribute the nerves throughout the body.
The most dangerous thing that can happen to patients is that the angioma damages the spinal cord. This can be done by compressing it for different reasons. The angioma can grow and directly damage the cord. It can also fracture the vertebra and indirectly cause the damage. The other possibility is that the angioma bleeds and causes a bruise that compresses the cord.
These complications, when they occur, are usually in the dorsal area of the spine and affect women more often than men. It must be made clear that the angioma is not a tumor that can become malignant or metastasize (this term refers to an extension of the tumor to a distant part of the body). It is a malformation that can grow and bleed and cause serious problems because of it.
What Are The Dangerous Angiomas?
The typical case that should be followed closely is the painful dorsal hemangioma that extends beyond the vertebral body. It can affect the posterior elements of the vertebra or the surrounding soft tissues and even, sometimes, cause the bone to splinter. This type of cases is assumed to be progressive and can lead to a spinal cord injury, so the follow-up must be very close, even requiring surgery.
I Have A Vertebral Hemangioma, Should I Check It Periodically?
Many patients wonder if they should receive periodic follow-up after discovering that they have an angioma in a vertebra. The reality is that most angiomas will never give any problem, not even pain. Today, only periodic monitoring is recommended if the angioma is causing pain symptoms (proven to be from there) or affecting the nerves that surround it. Those that do not produce symptoms and have been discovered by chance are unlikely to give any problem, so they do not require monitoring. There may be exceptions if our doctor sees that it has grown or if its shape, location, and size suggest that it may cause problems in the future.
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