Hemangioma of the spine: what is it, how dangerous, treatment
Hemangioma of the spine is one of the most frequent vascular tumors of the skeletal system. According to statistics, it suffers every tenth inhabitant of the Earth. Among the patients are women and the average age of onset is 20-30 years. It is believed that up to 80% of the fair sex after the age of 40 may suffer from this pathology.
Vertebral hemangioma for a long time may be asymptomatic, viewsas by accident, but the very first sign of the tumor is usually the pain with which the patient is sent for x-rays or MRI. Revealed hemangioma requires the solution of the question of the necessity and expediency of surgical treatment. The propensity to malignancy of the tumor does not show, however, the risk of dangerous complications require a serious approach.
The role of the spine cannot be overemphasized. It is the main support for the whole body, internal organs, the seat of the spinal cord, allowing us to feel pain, temperature, touch, and perform purposeful movement. The function of all internal organs obey the signals coming from the spinal cord. Novoobrazovaniya to the vertebrae can long time not to go beyond it and does not affect the spinal cord, however, the destruction of the structure of a vertebra, its fragility and instability, fraught with displacement, a fracture and compression of the very important nervous structures. The disorder is usually localized in the thoracic (th12) and lumbar (l1-l4) spine, affecting one or several vertebrae.
Causes and types of hemangiomas
Hemangioma is a vascular tumor, which is a tangle of interwoven and modified vessels. Usually there is damage to the vertebral bodies, but the possibility of tumor growth and cartilage layers.
Flawed vessels of the vertebra is formed inside the tumor. Under the influence of injuries or heavy loads occur hemorrhage, thrombosis, streamed blood cells stimulates osteoclasts to «cleanse» areas of damage, and it then fills the vacated space new defective tumor blood vessels. This process occurs continuously, leading to growth of tumors. The size of vertebral hemangioma rarely exceeds 1 cm.
Causes of hemangioma of the vertebrae can be:
- Genetic predisposition;
- Disc injuries.
It is established that in the presence of close relatives suffering from vascular tumors of the spine, the risk of hemangioma increased up to five times. Perhaps this is due to a genetic failure of the vascular walls, contributing to neoplastic transformation.
On the role of estrogens in the formation of tumors indicates the more frequent occurrence of pathology in women who get sick more often than men. In addition, during pregnancy, especially in the third trimester, it is noted an intense increase of the tumor is not only due to the changed hormonal background, but also due to increasing load on the spine.
Injury and excessive stress may contribute to the increased growth of the vascular component and the appearance of the tumor. If the hemangioma is already there, repeated mechanical effects enhance its growth.
Most commonly affects the thoracic spine (Th12) and lumbar. Tumor of the cervical is considered one of the most dangerous as it carries the risk of circulatory disorders of the brain. In the lumbar spine usually affects the arc l1-l4, which causes a variety of neurological disorders.
Depending on the nature of the current release:
About the aggressive course shows a rapid increase in the size of tumors, pronounced symptoms in the form of a compression syndrome, pathological fractures of the vertebrae. Aggressive is one in ten revealed a tumor.
Non-aggressive hemangiomas occur relatively favorable, grow slowly and asymptomatic, but in rare cases, small tumors or even spontaneous resorption.
Depending on the amount of damage to the hemangioma may be confined to the vertebral body, the rear semicircle, all vertebrae, and possible epidural growth above the soft brain shell.
Histological structure allows to distinguish among different types of tumors:
The capillary is constructed of small vessels of capillary type and is usually benign on the stream;
- Corpora – presents vascular cavities filled with blood, it flows from the intense pain and high risk of pathologic fracture;
The structure, size and location of hemangioma define it, especially the symptoms, treatment approaches and prognosis.
Symptoms of hemangioma of the spine
The symptoms of the tumor depend on its size and location relative to the vertebral body. For a long time a tumor hidden flows without causing any anxiety. Detected asymptomatic tumour accidentally, when the survey was conducted in connection with an injury or other pathology of the spine.
The earliest sign of the growing hemangioma becomes a pain, at first moderate, occurring periodically. Increasing neoplasms of the intensity of the pain increases, it becomes unbearable. Threat the size of the tumor (over 1 cm) contribute to the progression of not only pain, but also neurological disorders associated with disruption of the structure of the vertebrae and spinal cord compression.
For small tumors the pain is mild, often disturbs patients at night or after exercise, localized area of the affected vertebrae. When the involvement of spinal structures may numbness, paresis and paralysis, dysfunction of pelvic organs.
Hemangioma of the thoracic spine is manifested:
With the defeat of the cervical possible violation of blood flow in the brain, resulting in headaches, reduced mental capacity, insomnia, dizziness, impaired hearing and vision.
The lumbar region takes the second place in frequency of defeat. When this hemangioma localization (l1, l2, l3, l4) are possible:
- Pain in the lower back, groin, thighs;
- Numbness in the extremities;
- Paresis and paralysis of the legs;
- Dysfunction of the pelvic organs (especially with the defeat of the l3-4).
In adults in addition to the described neurological symptoms a symptom of aggressive hemangiomas may be infertility and impotence.
Hemangioma with aggressive course may cause very serious complications such as compression fractures of vertebral bodies, compression of the spinal cord and its roots, when paresis, paralysis and dysfunction of internal organs can acquire resistant and irreversible. To avoid this, the appearance of the above symptoms should consult a specialist.
It is important to detect a hemangioma on time until complications occurred and irreversible changes in the spinal cord. Examination of patients with low back pain, suspected hemangioma, requires the participation of a neurologist, neurocirugia, vertebrologist.
Diagnosis of hemangiomas involves:
Treatment of hemangioma of the spine
Treatment of hemangiomas of the spine can be considerable hardship because of peculiar localization. Simple elimination of the tumor can lead to instability of a vertebral, compression fracture and injury to the spinal cord or its nerve roots. The choice of rational method of treatment reserves the neurosurgeon after assessing the patient’s condition and the characteristics of the tumor.
Patients who are diagnosed with asymptomatic small hemangiomas may be offered surveillance with regular MRI control.
Indications for surgery are:
- The rapid growth of the tumor;
- Lose more than a third vertebra;
- Aggressive course of the tumor;
- The development of complications (compression of the spinal cord, its roots, pathological fracture).
To treat hemangiomas should be in specialized neurosurgical departments, with the experience and qualifications of a physician are of great importance. Drug treatment is only symptomatic and is aimed at eliminating pain and the inflammatory process.
For the treatment of vertebral hemangioma has been proposed various methods:
Removal of the tumor with open access and the resection portion of the vertebra was used with a 30-ies of the last century, however, this operation is very dangerous serious complications: bleeding from the vessels of education, malnutrition of the spinal cord, fracture of the vertebra. Because of the risk of such consequences, the intervention is used occasionally and in case of serious indications such as compression of the spinal cord or its nerve roots. To remove the tumor completely while open surgery is technically impossible, the surgeon may remove only part of it, located epidural.
If there is no escape and need such intervention, the preferred decompression techniques aimed at addressing the compression of a tumor of the spinal structures. Surgical treatment is often children, when the introduction of a cementing substance can cause the stop of growth of vertebra and a deformity of the spine in the future.
Alcoholism tumors involves the introduction in the tumor vessels of the ethanol solution, wherein the neoplasm is reduced due to the sclerosis of blood vessels. Immediate results of alcohol abuse can be satisfactory, because the swelling will decrease, but the downside will be the depletion of bone tissue of a vertebra, its destabilization and, as a consequence, a pathological fracture, a few months after the procedure. This fact makes extensive use of alcoholism in the hemangioma of the spine, although other tumor localization effect can be good.
Embolization of tumor vessels consists in introducing a special solution, leading to embolism of the vessels of tumors and disruption of its food. The active substance can be injected directly into the tumor (selective embolization), and in the nearby blood vessels. The disadvantage of this treatment can be considered a relapse due to the safety of small vessels supplying the hemangioma, as well as the disruption of the structure of the vertebra. In some cases, embolization was technically very difficult and even impossible, a complication may become an acute violation of blood circulation in the spinal cord.
Radiation therapy refers to the classical methods of treatment of hemangiomas of the spine, it is more safe than open surgery to remove the tumor. This treatment could be applied in many patients, because the irradiation is quite effective, but complications such as myelopathy, radiculitis, damage to the nervous fibers, skin reactions, do not allow it to be widely used. In addition, to eliminate tumors need a significant dose of radiation. Radiation therapy is contraindicated for children and pregnant women. Another unsolvable problem in radiation therapy is a violation of the integrity of vertebrae after reduction of the tumor, which contributes to pathological fractures after treatment. Currently, radiation therapy can be assigned to older patients with high operative risk.
A real breakthrough in the treatment of hemangiomas has been the application of puncture vertebroplasty proposed by the French doctors. The method consists in the introduction into the vertebra of special cementing substance mixed with barium sulfate (radiopaque substance) and titanium. This achieves several objectives: the tumor is reduced and ceases to grow, the vertebral body stabiliziruemost bone cement and compacted, the risk of fracture is minimal. Percutaneous vertebroplasty is considered the method of choice for hemangioma of the vertebrae, especially in cases of aggressive course of the tumor. It is possible as the primary method of therapy or as part of combination therapy.
For surgery the patient is placed on his stomach produced local anesthesia, while the patient is awake. Swelling in the damaged vertebra with a special conductor introduces a cementing substance. A good effect is achieved due to the high density of cement that eliminates the instability, fragility and vertebral fracture.
If necessary, can be made an additional fixation of the vertebrae with screws and decompression of the spinal cord. In the majority of patients after puncture vertebroplasty is pain, eliminated neurological disorders and restored their way of life and ability to work. Postoperative period runs usually well, within 2-3 weeks the patient is discharged from hospital.
It is worth remembering that there are contraindications to certain types of treatment in patients diagnosed with hemangioma. So, you can not use the vitamins and drugs that stimulate the immune system, as they can trigger an increase in neoplasms. Should eliminate physical exertion at the gym and at home, lifting weights. Contraindicated Solarium and tan in the sun, all kinds of warming treatments (bath, sauna).
Fans of physiotherapy is better to abandon all types of magnetic therapy. If the hemangioma is impossible to carry out the massage, as the mechanical effect on the spine can not only cause tumor growth due to increased blood flow, but to provoke such a dangerous complication as a compression fracture, requiring immediate treatment.
To prevent the growth of hemangiomas of the spine is almost impossible, especially in predisposed individuals, but it is advisable not to expose the vertebrae excessive physical exercise and to avoid injuries. If the tumor is discovered, not progressing, and not manifesting any symptoms, it is sufficient monitoring and MRI at least once a year. In symptomatic and aggressive hemangiomas, the patient will be offered treatment. The prognosis of hemangioma of the spine in most cases favorable.