Hemangioma on the spine
definition
Hemangiomas in the spine are common benign tumors that affect around one in ten people. They are rarely discovered and only rarely cause symptoms. A hemangioma is a so-called "blood sponges", which consist of blood vessels. Hemangiomas can occur anywhere in the body, but the most common locations are on the scalp, neck, liver, and bones. Hemangiomas in the spine are usually not a cause for concern. Only in rare cases can they cause symptoms and complications.
causes
The exact cause and development of the hemangioma is not fully known. As a rule, these are congenital tumors that arise during the embryonic period. There are several subtypes of hemangiomas that differentiate the exact cell composition of the small tumors. However, all variants are ultimately vascular malformations that can be very well supplied with blood and therefore get their red-bluish color.
The vascular malformations possibly arise from placental cells. In most cases, the cause of the development of a hemangioma is not investigated. In technical jargon, these tumors are often referred to as "idiopathic", which means that there is no recognizable cause. Hormonal changes during pregnancy are also discussed.
The hemangiomas usually grow within the first few months of life until they stop growing. In many cases, after about a year, the tumors will recede to the point of complete breakdown, which can take years. Large hemangiomas, on the other hand, often persist for life.The development of hemangiomas in adults is discussed. New hemangiomas can appear in old age, but these are probably due to a hereditary predisposition and pre-existing vascular dilation. A complete new formation of a true hemangioma in adulthood is rather unlikely.
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Concomitant symptoms
The hemangioma is a benign tumor that does not cause symptoms by itself. Because of this, a hemangioma of the spine is not discovered in most people or is discovered by chance in old age. Due to its location in the spine, however, the surrounding anatomical structures can be impaired, which can result in unpleasant and sometimes dangerous symptoms. Due to its location in the vertebral body, pain can occur when you are under pressure or at rest. The hemangioma can also press on blood vessels, muscles or the spinal cord, which, in addition to pain in this area, can lead to functional impairments and other neurological symptoms.
If the spinal canal grows inside the spinal canal, a so-called “spinal canal stenosis” can occur, which is associated with a narrowing of the spinal cord and neurological complaints. These can range from position-dependent movement and sensitivity disorders to complete paresis, severe pain and functional restrictions of the rectum and bladder.
Since the hemangioma is an expansion of blood vessels, minor injuries and bleeding from the hemangioma can always occur. Depending on the size of the tumor, this can sometimes lead to undetected major bleeding, which in turn causes neurological symptoms and back pain.
Is Hemangioma Pain?
The majority of all hemangiomas are symptom-free and therefore painless. On the spine, the hemangiomas can lie in the vertebral body or in the vertebral arch and cause pressure pain in the respective vertebral body by displacing the bone. However, the pain from the hemangioma is rarely severe. Worse pain and symptoms are only to be expected when a hemangioma grows into the spinal canal and leads to a constriction with involvement of nerves. This can sometimes cause relieved, pulling pains in various parts of the body.
Vertebral fracture
A vertebral fracture is a rare complication of hemangiomas. Hemangiomas of the spine are often located in the vertebral body and therefore in the most stable part of the vertebra. In this area there are great forces on the spine. The stability of the vertebral bodies can be influenced by tumors of any kind. In contrast to healthy bones, the hemangioma cannot withstand the daily weight loads, which is why even slight movements and harmless impacts can lead to so-called “sintering fractures”. The unstable vortex collapses and loses its original height. This type of fracture is also typical in osteoporosis. A vertebral fracture from a hemangioma is usually not as dramatic as a vertebral fracture in a healthy young person.
Hemangioma vertebrae
This is the most common benign tumor disease of the spine. Hemangiomas mainly affect the thoracic and lumbar spine. A hemangioma vertebra is rarely noticed by those affected. The eddy can be noticed for the first time through routine examinations or through a sintering fracture. Occasionally there may also be mild pressure pain in the spine. As a preventive measure, a hemangioma vertebra can be surgically replaced with bone material.
What is an atypical hemangioma of the spine?
There are no differences between a typical and an atypical hemangioma in terms of origin, nature and symptoms. For the diagnosis of hemangioma, there are radiological criteria that clearly indicate a hemangioma. An atypical hemangioma, on the other hand, can look very variable in the radiological ultrasound, X-ray, CT or MRI image and does not allow a reliable diagnosis. Atypical hemangiomas can be very inhomogeneous, irregular and unclear in the images. Not infrequently they resemble a metastasis. Overall, however, the atypical hemangiomas are in most cases harmless and do not pose a threat.
diagnosis
In most cases, hemangiomas are not recognized and often do not require any treatment for life. However, some hemangiomas are discovered incidentally during x-ray checks of the spine. Symptomatic hemangiomas are rare.
Chronic pressure pain in a vertebral body, possibly with neurological symptoms of the spinal canal, is an indication for an X-ray, CT or MRI check. The radiological picture shows irregularities in the structure of the vertebral bodies if hemangiomas are present. In the case of typical hemangiomas, the radiologist can use the structure to differentiate the hemangioma from malignant tumors and metastases. If anything is unclear, a biopsy of the tumor can be performed with a needle. This allows the hemangioma to be clearly diagnosed in the laboratory.
How does it look in the MRI?
Magnetic resonance tomography is suitable for displaying soft tissue in high resolution. Compared to the X-ray and CT examination, however, it is complex and expensive, but it has a high resolution and does not require radiation. On the spine, the MRI scan is often used for herniated discs or spinal canal stenosis. In most cases, hemangiomas are incidental findings. The benign tumors mainly consist of blood vessels and fat tissue, which is why they look hyperintense in the MRI image and therefore lighter than bone tissue. In the cross-section of the vertebral body, there is often additional vertical banding.
therapy
Hemangiomas rarely require treatment. They can be removed from the skin for aesthetic reasons, but their removal is more complex from the spine. If they are discovered as an incidental finding, they can be treated for preventive reasons in order to prevent possible spinal cord problems or sintering fractures. To do this, the hemangioma has to be surgically removed and filled with bone substance.
If vertebral body fractures have already occurred, the vertebral body can be cemented and stabilized or stiffened with other vertebrae. To do this, several vertebral bodies are screwed together with rods and thus stabilized.
Radiosurgical treatments can also rarely be used to reduce the hemangioma. To do this, the vertebral body is irradiated. These procedures can be used as a second choice when surgery is not possible or makes no sense.
If there are no symptoms, the need for an operation must be carefully considered in each case. Mild complaints without neurological consequences should first be treated symptomatically with painkillers before surgical treatment is initiated.
Can a Hemangioma of the Spine Become Malignant?
Typical congenital hemangiomas are not malignant. These are purely benign tumors from the embryonic period, which consist of vascular and fat cells and have no tendency to degenerate.
Nevertheless, when examining a supposed hemangioma, attention should be paid to possible characteristics of malignant tumors. If the hemangioma grows unusually quickly and irregularly, if the tumor bleeds frequently, or if the tumor spreads deeply, it should be examined for any malignant degeneration.
