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Jul 30

Spinal Angioma

Most hemangiomas are coincidental findings when performing an imaging test such as MRI. At the moment we see the result many questions arise, so I want to explain in this post what it consists of and how we should handle it. Vertebral angioma is a vascular structure (formed by tissue from blood vessels) that is placed inside the vertebra due to an error in the embryonic development. Although they are referred to as benign tumors they really are a malformation of vascular structure. They are very frequent, in such a way that we see them in up to 10% of the people we examine. The lesion occupies a space in which there should be bone.

What symptoms does a hemangioma produce?

In the vast majority of cases, none. As I mentioned before, we met with them by chance when evaluating the spine on x-ray, MRI or other tests. The haemangiomas that we can worry about are those that produce pain or neurological symptoms or those that are at risk of doing so.

Occasionally there may be doubts as to whether the angioma is producing pain since it is often accompanied by arthritic signs and lesions on the disc, for example. For this reason, if the angioma is limited to the body of the vertebra and is in the cervical or lumbar zone, chances are that they will not evolve and we assume that they are not dangerous. Hemangiomas that do not give symptoms are usually found in the lumbar or dorsal area and are limited to being contained in the body of the vertebra.

Spinal Angioma What is the risk of an angioma?

It should 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 around them. Remember that the vertebrae surround the spinal cord, which is the structure that contains the nerves that go down the brain to distribute the nerves throughout the body.

The most dangerous thing that can happen to us 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 marrow. It can also fracture the vertebrae and indirectly cause damage. The other possibility is that the angioma begins to bleed and causes a hematoma that compresses the marrow.

These complications, when they occur, are usually in the dorsal area of ​​the spine and affect women more frequently than men. It should be made clear that the angioma is not a tumor that can become malignant or that can metastasize. It is a malformation that can grow and bleed and give serious problems because of it.

What are 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 soft tissues around and sometimes even cause the bone to splinter. These types of cases are assumed to be progressive and may lead to spinal cord injury, so follow-up should be very narrow and even require surgery.

I have a vertebral angioma, should I check it periodically?

Many patients wonder if they should receive periodic follow-up after discovering they have an angioma in a vertebra. The reality is that most angiomas will never give you any problems, not even pain. At present only a periodic surveillance is recommended if the angioma is causing symptoms of pain (that is proven that it proceeds from there) or affectation of the nerves that surround to him. Those who do not produce symptoms and have been discovered by chance are unlikely to give any problems so they do not require monitoring. There may be exceptions if our doctor sees that he has grown or if his shape, location and size suggest that he may give problems in the future.

How is the diagnosis of a vertebral hemangioma diagnosed?

Angiomas can be seen many times in almost any test of image being the scanner and the magnetic resonance the best way to see them. Most of them have characteristics that define it and will be detected without problems.

More aggressive hemangiomas may not have the typical characteristics and may be confused with other types of vertebral tumors such as metastases. In these cases it may be necessary to perform biopsies to reach the diagnosis.

What is the treatment of an angioma?

In most cases you will not need any treatment because it will not give you any problems, either current or future. Less aggressive angiomas have been treated in different ways such as radiotherapy, embolization of the arteries that feed it, alcoholic injections or vertebroplasties (injection of cement into the vertebral body).

More aggressive hemangiomas require surgery to decompress and stabilize the spine with instrumentation. Occasionally a resection is performed (remove the injured area) although it is the most risky option. Other times, surgery is combined with some of the techniques mentioned above.

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