Symptomatic Hemangioma of the Spine

Abstract

Hemangioma of the vertebra, which in most instances is encountered as an incidental roentgen finding, becomes a lesion of prime importance when it is associated with compression of the spinal cord. Although such lesions had undoubtedly been recognized much earlier, Virchow was the first to report the presence of a vertebral hemangioma in 1863. Probably the first description of associated neurologic manifestations was presented by Gerhardt (Germany) in 1895 (8). It was not until 1926, however, that the presently accepted characteristic roentgenographic features of the lesion were brought to our attention by Perman (11). Until that time only 8 cases of vertebral hemangioma associated with compression myelopathy had been reported, the diagnosis having invariably been made at autopsy. Since then, numerous cases haveappearedin the literature. Bailey and Bucy (1), in 1929, were the first in this country to report a case of hemangioma of the vertebra associated with compression of the spinal cord. Treatment consisted in laminectomy followed by roentgen irradiation. Schlezinger and Ungar (11), in 1939, were among the first Americans to emphasize the unquestionable value of the roentgen rays in the primary treatment of hemangioma of the vertebra with secondary compression myelopathy. In cases manifesting marked compression of the spinal cord and in rapidly progressing compression myelopathies, they advocated surgical intervention (laminectomy) followed by irradiation. In 1941 Ghormley and Adson (8), in an analysis of 39 cases of hemangioma of the vertebra associated with neurologic disturbances of varying degree, concluded that in patients with paraplegia, decompressive laminectomy with postoperative roentgen therapy produced the best clinical response; whereas in patients who exhibited local symptoms or evidence of compression myelopathy, without the presence of paraplegia, irradiation was the procedure of choice. Ferber and Lampe (5), in 1942, reported a case of hemangioma of the seventh thoracic vertebra with compression of the spinal cord in which roentgen therapy was the sole method of treatment. Almost complete recovery resulted. They cited 12 cases from the literature in which roentgen therapy alone was used, with complete clinical recovery in the majority and marked improvement in the remainder. Kaplan (9) in 1946 stated that irradiation may be expected to effect a cure in hemangioma of the vertebra (with spinal cord compression) if the diagnosis is made before irreparable damage to the cord has taken place. He supported this observation with the report of a case associated with extensive spinal cord compression in a 12-year-old boy, in which a complete cure was effected following postoperative roentgen therapy. A case of epidural hemangioma associated with vertebral hemangioma and spinal cord compression, in which complete clinical improvement was obtained with x-ray therapy alone, was also reported by Foster and Heublein (6).