- Department of Neurosurgery, University Hospital of Patras, Rio University Hospital, Patras, Achaia, Greece.
DOI:10.25259/SNI_888_2020Copyright: © 2020 Surgical Neurology International 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.
How to cite this article: Dimitrios Papadakos, Spiros Boulieris, Andreas Theofanopoulos, Dionysia Fermeli, Constantine Constantoyannis. Tubular laminectomy and percutaneous vertebroplasty for aggressive vertebral hemangioma. 20-Jan-2021;12:27
How to cite this URL: Dimitrios Papadakos, Spiros Boulieris, Andreas Theofanopoulos, Dionysia Fermeli, Constantine Constantoyannis. Tubular laminectomy and percutaneous vertebroplasty for aggressive vertebral hemangioma. 20-Jan-2021;12:27. Available from: https://surgicalneurologyint.com/surgicalint-articles/10532/
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.
Keywords: Aggressive vertebral hemangiomas, Percutaneous vertebroplasty, Tubular laminectomy
Vertebral hemangiomas (VH) are benign vasoformative neoplasms of endothelial cells that grow within marrow spaces in the bone and encase bony trabeculae.[
Hereby, we present a patient with an AVH and a progressive paraparesis who benefitted from a minimally invasive T9 decompression with vertebroplasty.
A 59-year-old male presented with a 2-year history of intermittent back pain and in the past 2 months progressive myelopathy. On examination, he exhibited tenderness over the midline thoracic spinous processes, diffuse lower extremity hyperreflexia and spasticity. The thoracic CT revealed an osteolytic lesion with the characteristic “polka dot” or “salt and pepper” sign on the axial images and the “corduroy cloth” or “jail bar” sign on the sagittal images involving T9 [
A minimally invasive T9 tubular unilateral laminotomy was performed to achieve decompression of the spinal canal. This was followed by a bilateral percutaneous vertebroplasty with biopsy. The postoperative CT and MRI scans showed adequate decompression of the thoracic spine, satisfactory cement location within the T9 body, with no cement leakage [
AVHs are rare conditions with varied available treatment options.[
Preoperative angiography to determine the vascularity of the tumor, followed by tumor embolization, is useful to decrease intraoperative blood loss.[
Minimally invasive tubular laminectomy combined with percutaneous cement vertebroplasty and biopsy is a safe and efficacious procedure for the treatment of thoracic symptomatic AVHs.
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