Tubular laminectomy and percutaneous vertebroplasty for aggressive vertebral hemangioma

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Abstract

Background:

Vertebral hemangiomas (VH) are the most common benign vascular neoplasms of the spine. Aggressive VH (AVH) may become symptomatic due to soft-tissue expansion/extraosseous extension into the paraspinal and/or epidural spaces. There are several options for treating painful AVH, including radiotherapy and/or open surgery.

Case Description:

A 59-year-old male presented with a 2-year history of intermittent back pain and progressive thoracic myelopathy in the past 2 months. MRI revealed a T9 level lesion, with high-intensity signal on both T1 and T2 images and an extraosseous component with significant cord compression. We performed minimally invasive tubular unilateral laminotomy for bilateral decompression of the thoracic spine at the T9 level, followed by bilateral percutaneous vertebroplasty with biopsy. Postoperatively, the pain was immediately relieved, and the myelopathy improved. The biopsy confirmed the diagnosis of a VH.

Conclusion:

Combining minimally invasive techniques consisting of tubular laminectomy and percutaneous vertebroplasty are safe and effective ways for treating AVHs.

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Most cited references 16

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The natural history and management of symptomatic and asymptomatic vertebral hemangiomas.

M W Fox, B M Onofrio (1993)

Fifty-nine cases of vertebral hemangioma were seen at the Mayo Clinic between 1980 and 1990. Vertebral hemangiomas were discovered incidentally in 35 patients, while pain was the presenting complaint in 13 patients. Five patients presented directly with progressive neurological deficit requiring surgery, and six patients had surgery elsewhere for spinal cord compression and were referred for follow-up evaluation. To better define the natural history of these lesions, a historical review of these patients was conducted; progression of an asymptomatic or painful lesion to neurological symptoms was found in only two cases (mean follow-up period 7.4 years, range 1 to 35 years). New-onset back pain followed by subacute progression (mean time to progression 4.4 months, range 0.25 to 12 months) of a thoracic myelopathy was the most common presentation for patients with neurological deficit. Initially, all 11 patients with spinal cord compression underwent decompressive surgery with full neurological recovery. Recurrent neurological symptoms were observed in three of six patients following subtotal tumor resection and postoperative administration of 1000 cGy or less radiation therapy (mean follow-up period 8.7 years, range 1 to 17 years). No recurrences were noted in four patients who had subtotal excision plus radiotherapy between 2600 and 4500 cGy. One other patient had gross total tumor removal without radiotherapy and has not had a recurrence. Based on these patients and a review of the literature, the authors recommend annual neurological and radiological examinations for patients with hemangiomas associated with pain, especially young females with thoracic lesions in whom spinal cord compression is most likely to develop. Radiation therapy or embolization is an effective therapeutic alternative for patients with severe medically refractory pain. Regular follow-up monitoring for patients with asymptomatic lesions is unnecessary unless pain develops at the appropriate spinal level. It is concluded that management of patients with a progressive neurological deficit should include preoperative angiography and embolization, decompressive surgery with the approach determined by the degree of vertebral involvement and site of spinal cord compression, and postoperative radiation therapy in patients following subtotal tumor removal. Operative management and complications are discussed.

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A minimally invasive technique for decompression of the lumbar spine.

Bernard Guiot, Larry Khoo, Richard Fessler (2002)

The technical feasibility of percutaneous microendoscopic bilateral decompression of lumbar stenosis via a unilateral approach was evaluated in a human cadaver model. The purpose of this study was to determine the feasibility of using a microendoscopic laminotomy technique to treat spinal stenosis. Minimally invasive surgery is an important means of reducing tissue trauma and patient morbidity. This may prove to be essential in improving pain and in reducing postoperative stress responses and delayed sequelae that can lead to unfortunate complications after otherwise uneventful procedures. To date, minimally invasive lumbar endoscopic techniques have not been used to decompress the lumbar spinal canal. In each of four cadavers, the laminae of L1 through L4 were subjected to one of four procedures consisting of unilateral microendoscopic laminotomy, bilateral microendoscopic laminotomy, unilateral open laminotomy, and bilateral open laminotomy. Every procedure was performed once at all levels. Computed tomography was performed before and after laminotomy to establish the extent of decompression of the spinal canal, and measurements of the midsagittal, interpedicular, and decompression diameters were taken. The four procedures were successfully performed at every level. Satisfactory decompression of the spinal canal was achieved regardless of the approach used. The exiting nerve roots were well visualized when any one of these techniques was used. Complications, including dural tears and facet complex instability, were independent of the procedure performed. Microendoscopic laminotomy can be used to decompress the spinal canal as effectively as an open laminotomy and may prove to be beneficial in decreasing the complications and morbidity of standard treatments for lumbar stenosis.

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Comprehensive management of symptomatic and aggressive vertebral hemangiomas.

Dean Chou, Susan Weinstein, Ivan Acosta … (2007)

Conservative surgical strategies are appropriate for most symptomatic hemangiomas causing cord compression without instability or deformity. Even so, complete intralesional spondylectomy following embolization of aggressive vertebral hemangiomas with circumferential vertebral involvement can be safely accomplished. Such a spondylectomy can also prevent recurrence of hemangiomas. Transarterial embolization without decompression is an effective treatment for painful intraosseous hemangiomas. Vertebroplasty is useful for improving pain symptoms, especially when vertebral body compression fracture has occurred in patients without neurological deficit, but is less effective in providing long-term pain relief.

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Author and article information

Contributors

Dimitrios Papadakos

Spiros Boulieris

Andreas Theofanopoulos

Dionysia Fermeli

Constantine Constantoyannis

Journal

Journal ID (nlm-ta): Surg Neurol Int

Journal ID (iso-abbrev): Surg Neurol Int

Title: Surgical Neurology International

Publisher: Scientific Scholar (USA )

ISSN (Print): 2229-5097

ISSN (Electronic): 2152-7806

Publication date Collection: 2021

Publication date (Electronic): 20 January 2021

Volume: 12

Electronic Location Identifier: 27

Affiliations

[1]Department of Neurosurgery, University Hospital of Patras, Rio University Hospital, Patras, Achaia, Greece.

Author notes

[* ] Corresponding author: Constantine Constantoyannis, Department of Neurosurgery, University Hospital of Patras, Rio University Hospital, Patras, Achaia, Greece. cconst@ 123456upatras.gr

Article

Publisher ID: SNI-12-27

DOI: 10.25259/SNI_888_2020

PMC ID: 7881512

PubMed ID: 33598343

SO-VID: 3572d419-226c-45a4-a6c7-a3f1a0216ef4

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

History

Date received : 08 December 2020

Date accepted : 23 December 2020

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Tubular laminectomy and percutaneous vertebroplasty for aggressive vertebral hemangioma

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Abstract

Background:

Case Description:

Conclusion:

Related collections

25th European Students' Conference

Most cited references 16

The natural history and management of symptomatic and asymptomatic vertebral hemangiomas.

A minimally invasive technique for decompression of the lumbar spine.

Comprehensive management of symptomatic and aggressive vertebral hemangiomas.

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Contributors

Journal

Affiliations

Author notes

Article

History

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Cited by 1

Most referenced authors 154