Hemangioma is a type of benign (non-cancerous) tumor formed due to an abnormal buildup of blood vessels. Such benign lesions can develop on the skin as well as in internal organs including bones. As far as the skeletal system is concerned, the vertebral column and the skull are the common sites, and the involvement of other bones is rare. The hemangiomas formed on the vertebrae are termed spinal or vertebral hemangiomas.
Spinal hemangiomas arise due to the overproliferation of endothelial cells in the body of the vertebra. These cells normally form the lining of blood vessels, and are crucial for synthesis of new blood vessels. Being benign in nature implies that these tumors do not spread to other parts of the body.
These tumors are generally seen in the lower thoracic or the upper lumbar regions of the spine, and involve only one vertebra in most cases. They are more common in adults between 50 and 70 years of age, and are twice more often in women.
Given below are the various causes, symptoms, and treatment options for this condition.
Bone hemangiomas represent a condition with unclear etiology. The exact cause of this condition is unknown but genetic predisposition has been suggested as a vital factor. Some studies have indicated an association between tissue injury as well as tissue hypoxia with hemangioma development. Certain studies claim that increased amount of estrogen circulating after birth may be an important causative factor; and that this may be a reason for their predominance in women.
An extremely rare disease called the Gorham's Disease (Gorham's vanishing bone disease or phantom bone disease) is characterized by bone loss, and abnormal growth of blood vessels. As a result, formation of multiple bone hemangiomas is observed in such individuals. However, the etiology for this disease is unclear as well.
Vertebral hemangiomas are slow-growing tumors, and mostly affect vertebrae in the lower back region. Clinically, they are divided into three main categories:
» Asymptomatic vertebral hemangioma: These are the most common type amongst them. They remain clinically silent, and do not lead to manifestation of any symptoms.
» Symptomatic vertebral hemangioma: These represent about 1% of all the vertebral hemangiomas, and are characterized by painful lesions, swelling of the soft tissues (tissues surrounding bones), and lower back pain. Rare instances of spinal fractures have also been observed.
» Compressive vertebral hemangioma: When the tumorous mass disrupts the normal tissue structure and compresses the nerve roots present in the vertebral body, they are termed compressive vertebral hemangiomas. Such compression leads to neurological symptoms like radiating pain along the compressed nerve, as well as weakness, numbness and/or difficulty in controlling the associated muscles. In extreme cases, it may lead to paralysis as well.
Being asymptomatic in most individuals, a hemangioma of the spine often gets diagnosed while investigating other health conditions. The condition is often diagnosed through imaging techniques like radiography, magnetic resonance imaging (MRI) and computerized tomography (CT). These benign tumors show a typical pattern of striations and vascular spaces, that give a characteristic 'polka dot' or 'honeycomb' appearance. One may also see a varying degree of loss in vertebral height.
Several treatment options ranging from radiation therapy to surgery, have been indicated in case of spinal hemangiomas associated with neurological symptoms. However, in many cases of completely asymptomatic and stable tumors, no treatment is advised. However, such individuals are advised to monitor the growth of tumors through regular tests.
One or a combination of the following treatment options may be suggested, depending on the severity of symptoms, size of the tumor as well as the degree of nerve compression.
» Radiation therapy involves irradiation of the tumor with X-rays or gamma rays to reduce its size. Currently, it is emerging as a low-cost and non-invasive treatment option, and is becoming increasingly common.
» Embolization is a minimally invasive procedure through which blood supply to the spinal tumor is cut off. This halts tumor progression.
» Vertebroplasty and kyphoplasty may be advised in the event of spinal fractures due to compression by the tumors. These are minimally invasive techniques, and involve the injection of a type of bone cement into the fractured vertebra. This cement quickly hardens, and provides stability and support to the vertebra. Kyphoplasty involves an additional step of creation of a void in the vertebra before injecting the cement. This void is created by introducing a compressed balloon in the appropriate region of the vertebra and then inflating it.
» Intralesional alcohol injection, that involves administration of ethanol into the tumor, may be used in order to destroy it and relieve the resulting spinal cord compression.
» Surgical removal of the tumor as well as a parts of the affected tissue may be advocated in some cases. However, surgery is normally suggested as the last option.
This is a benign condition and generally does not lead to any severe, debilitating symptoms. However, it is advisable not to ignore any persistent or recurrent episodes of back pain and numbness of limbs, and seek professional medical consultation to investigate their precise etiology.
Disclaimer: This HealthHearty article is for informative purposes only, and should not be used as a substitute for professional medical advice.