Vertebral Angioma

; to be precise, it is a hemangioma that originates from the rapid and uncontrolled proliferation of an epithelial cell of a blood vessel, intended for the supply of a vertebrae of the spine.

Image from Radiopedia.com - See more Photos Vertebral Angioma

With still unknown causes, vertebral angioma is only rarely a symptomatic condition; specifically, in such circumstances, the typical symptoms are: back pain, muscle weakness, numbness and numbness in the lower limbs, paralysis of different body areas, loss of control of the anal and bladder sphincters and deformation of the spinal column.
An accurate diagnosis of vertebral angioma involves doing an X-ray and MRI of the spine, as well as an angiography.
Planning and conducting treatment for vertebral angioma only takes place when the condition is symptomatic.

Brief review of what "is a hemangioma

A hemangioma is a particular benign tumor, belonging to the category of angiomas, which originates from the abnormal proliferation of a typical endothelial cell of the inner wall of blood vessels.
Made up of a dense agglomeration of capillaries and slightly larger blood vessels, a hemangioma can:

Appear as a smooth patch, raised papule, or thick lump
Be red or purple in color;
Reside on the skin (cutaneous localization), in the dermis, on the mucous membranes or internal organs (brain, heart, spleen, liver, respiratory tract, bones, etc.).

According to the most recent classifications, there are three types of hemangioma: capillary hemangioma, cavernous hemangioma and pyogenic granuloma (for their characteristics, see the table below).

Table. Subtypes of hemangioma and their main characteristics. Subtype Location Appearance Capillary hemangioma (eg: ruby angioma and "newborn angioma")

Skin

Smooth patch or raised papule
Red or purple color

Cavernous hemangioma or cavernoma (e.g. liver angioma)

Dermis
Internal organs

Nodule
Red or purple color

Pyogenic granuloma

Skin
Mucous membranes

Nodule
Red

, more likely to be found in the population over thirty.

where the benign tumor is located. It is the result of the compression that the vertebral angioma exerts on the spinal cord, contained within the vertebra on which the benign tumor in question is located.
If the vertebral angioma is particularly large or grows larger over time, the painful sensation may spread elsewhere and affect the upper (arms and hands in particular) and lower limbs (especially hips, legs and feet).

Sense of muscle weakness in the lower limbs. It is a possible consequence of the compression that the vertebral angioma can exert on the sensitive nervous structures (sensory spinal nerves), located near the vertebra on which the benign tumor is located.

Numbness and numbness along the lower limbs; paralysis of varying degrees and affecting different areas of the body. There are other possible consequences of the nerve compression produced by the vertebral angioma, to the damage of the neighboring sensory spinal nerves.

Loss of control of the anal and bladder sphincters. It is a consequence of the compression that a large vertebral angioma can cause in the spinal cord.

Spinal deformation. It depends on the infiltration of the vertebral angioma at the level of the host vertebra. This phenomenon, in fact, involves a modification of the affected vertebra, which leads to the collapse (or subsidence) of the latter and to an alteration of the overall structure of the rachis.

Factors that make a vertebral angioma a symptomatic presence:

Large size of the tumor mass
Compression of the spinal cord
Compression of the sensory spinal nerves
Infiltration of the benign tumor on the vertebra that hosts it and consequent vertebral collapse

When to see a doctor?

In general, the sudden onset of symptoms, such as back pain, a sense of muscle weakness and numbness in the lower limbs, loss of control of the anal sphincters, is always a valid reason to contact your doctor immediately and schedule a check-up. and bladder, loss of sensation in the lower limbs and paralysis of some parts of the body.
For people with asymptomatic vertebral angioma, the recommendation is to consult a doctor experienced in spinal pathologies when the benign tumor begins to manifest itself with the aforementioned symptoms.

Complications

The complications of a vertebral angioma obviously concern only the symptomatic cases and consist in a worsening of the symptoms, such as to seriously compromise the quality of life of the patients.
Regarding a possible malignant evolution of the vertebral angioma (ie the transformation of the vertebral angioma into a malignant tumor of the spine), this feared phenomenon is very rare, if not impossible.

makes the benign tumor in question an unsuspected presence.

How to diagnose symptomatic vertebral angioma

Canonically, the diagnosis of symptomatic vertebral angioma is based on: a thorough physical examination, a thorough medical history, x-ray of the spine, nuclear magnetic resonance of the spine and angiography (or, alternatively, angioTAC).

OBJECTIVE EXAMINATION AND HISTORY

Physical examination and anamnesis essentially consist in the observation and critical study of the symptoms manifested by the patient.
They always constitute the first step in the process of examinations and tests that lead to the diagnosis of vertebral angioma.

RADIOGRAPHY AND NUCLEAR MAGNETIC RESONANCE OF THE SPINE

Although with different technologies and physical principles, radiography and nuclear magnetic resonance of the spine provide detailed images of the entire spine and, in the presence of vertebral angioma, allow to identify the precise site of the latter.
Nuclear magnetic resonance is a more detailed instrumental test than radiography; from the observation of his images, in fact, doctors are able to see if the vertebral angioma has formed close to some spinal nerve and is causing its compression.

ANGIOGRAPHY

By injecting a contrast agent visible on X-rays into a blood vessel, angiography allows doctors to study various characteristics of the vertebral angioma, including size, density of blood vessels forming the tumor mass, precise location, and so on.
Its alternative - the so-called angioTAC - works a little differently, but it serves the same purposes.

Curiosity

An examination such as angiography is particularly important when the vertebral angioma requires surgical treatment aimed at its removal.

. It consists in "bombarding" the benign tumor with a certain dose of ionizing radiation.
Radiation therapy stops the growth of the vertebral angioma and promotes its regression, but is unable to eliminate it completely.
However, except for the aforementioned limitation, it is a very precise treatment.

Vertebrectomy. It is the delicate and radical surgical operation of removing, from a vertebra, the so-called vertebral body (NB: the vertebral body is one of the main components of a vertebra), followed by the grafting (or transplantation) of a suitable replacement element (in order to to guarantee the same functions offered by the removed body).
The vertebrectomy performed due to a vertebral angioma has as its object the vertebra on which the aforementioned tumor resides, in order to eliminate the latter definitively and resolve the entire symptomatological picture.

Laminectomy. It is the delicate surgery on the spine, which involves the removal of the so-called vertebral lamina (N.B: it is a characteristic element of the vertebrae), in order to reduce the symptoms related to the compression of the spinal cord and the sensory spinal nerves.
Laminectomy is usually a symptomatic treatment, but it can also be a causal therapy, when the vertebral angioma resides on the vertebral lamina being removed.

Kyphoplasty and vertebroplasty. These two particular procedures are used when the vertebral angioma has caused the collapse of the vertebra on which it was formed. Kyphoplasty and vertebroplasty, in fact, allow to remedy the vertebral collapse and to recover the normal anatomy of the vertebral column, through injection, in the vertebra of interest, of a cementing substance or silicone, both having a supporting function.
For the avoidance of doubt, it should be noted that carrying out a kyphoplasty or a vertebroplasty does not allow to eliminate the vertebral angioma, but only to improve the symptomatological picture.

Injection of ethanol into the blood vessels of the tumor. It favors the coagulation of the circulating blood inside the blood vessels constituting the vertebral angioma.
It is usually a preparatory treatment for one of the aforementioned surgical techniques, in order to reduce the risk of bleeding.

Embolization. It consists of the injection into the vertebral angioma of a special self-coagulating resin which, solidifying, prevents the blood from flowing inside the vessels constituting the benign tumor in question.
Embolization represents one of those preparatory treatments for the surgical removal of the vertebral angioma, carried out with the aim of reducing the risk of bleeding.