What Is a Spinal Hemangioma?

A spinal hemangioma is a benign vascular tumor of the spine. These growths classically appear in the thoracic and lumbar spine, located in the mid to lower back. While the tumor is not dangerous, it can cause pain and discomfort, and treatment may be recommended for these reasons. Spinal surgeons are usually involved in the evaluation and treatment of patients with spinal hemangiomas and patients can access especially good treatment at spinal centers, facilities specializing solely in spinal care.

The causes of spinal hemangiomas are not well understood. Some people appear to have a genetic predisposition, while other people do not, and the tumors can take a variety of forms. Patients can experience symptoms like pain, numbness, and tingling, both at the tumor site and in another areas of the body if the tumor puts pressure on the spinal nerves. To diagnose this condition, a doctor will need to order a medical imaging study of the spine.

Tests like MRIs are commonly used to evaluate patients with suspected spinal problems, and a contrast agent may be used to highlight the spinal structures. For this test, patients lie on a table after being injected with the contrast agent and are wheeled into an MRI machine for imaging. A radiologist can examine the images and check for abnormalities. If any are found, spine specialists can look at the films to collect more information for use in diagnosis and the development of a treatment plan.

Often, the recommendation for this condition is no treatment. If the patient is not experiencing severe symptoms and the tumor appears stable, followups will be recommended periodically to see if it is growing and to check for new symptoms, but otherwise the tumor will be left alone. For patients in pain and in cases where there are concerns about pinching the spinal nerves, treatment may be recommended to address the tumor before it has an opportunity to cause more problems for the patient.

One option is embolization, where the blood supply to the tumor is cut off, arresting the growth and forcing it to shrink over time. A spinal hemangioma can also be removed surgically or treated with radiation therapy. Once the growth is resolved, the patient should experience a significant improvement. If symptoms continue to linger, further medical evaluation is needed to check for signs of permanent damage to the spine. Treatment options for chronic pain caused by a spinal hemangioma can include electrical stimulation of the nerves, as well as pain medications.

For many people, a hemangioma exists for many years before it is noticed. Individuals don’t often have imaging done of the mid or lower back without cause, and it can make changes in the way an individual feels or certain neurological concerns before an x-ray, MRI or CT scan reveals the tumor. Only about 5% of the population who have a hemangioma will develop symptoms, leading to some discrepancies with how long it has existed and how much it has grown. The significant signs of damage to the spinal column, the nerves or the amount of compression experienced by the spinal cord or canal can give some insight into the overall development of the tumor.

Doctors look for a lattice-shaped or honeycomb-looking mass within the bone to help determine where a suspected spinal hemangioma may be. When discovered and monitored, physicians find that these tumors grow very slowly. However, it is the impact on the surrounding area that determines the seriousness of the size. When the hemangioma is in one location it can cause pain, but as it grows, it can move past the boundaries of the bone and cause the vertebra to collapse.

In turn, this puts immense pressure on the spinal cord and surrounding nerves. This can cause pain to radiate into the legs or arms, cause numbness or weakness and compromise bladder or bowel control. The progression of symptoms in an individual identifies how quickly the tumor may be growing, but the overall growth pattern is different for each individual.

When patients hear the word tumor, the first thoughts are generally of fear of cancer. Spinal tumors are abnormal masses of tissue that are located in or around the spinal column or spinal cord, and the growth of the cells can wreak havoc on the body when determined to be malignant or cancerous. Hemangioma is made up of abnormal blood vessels and it could mimic a malignant lesion when looking at both radiological and clinical behavior.

The organization of the hemangioma can contribute to clarifying whether this type of tumor is benign or malignant, as recurrent trauma has been thought to induce the development of a tumor as a result of mechanical irritation. The response to trauma could increase blood flow into a preexisting lesion. Hemangiomas can be defined as typical, atypical and aggressive, and once symptoms are present, imaging will determine the location and size of the tumor. While surface hemangiomas are often seen at birth, locations in the spine generally develop after 30 but are closer to age 50.

Imaging results that reveal a mass typically generate concern for both patient and provider, and further testing is often needed to determine the exact nature of a mass. Hemangiomas of the spine are typically diagnosed through magnetic resonance imaging (MRI) or computed tomography (CAT scan). These devices produce images of the tissues and bones surrounding the spinal cord. For some scans, extra clarity is provided by injecting a patient with a contrast-enhancing agent. This can help physicians tell the difference between a metastatic or cancerous tumor and a benign hemangioma.

There are several signs that reveal a vertebral hemangioma over a malignant tumor. One sign is thick vertical bands that have developed in the affected bone. These bands alternate in a pattern with normal bone that looks like corduroy stripes. When a horizontal cross-section of bone is scanned, the resulting sign looks more like polka-dots. This view shows circular slices of the thickened band within the normal bone tissue, resulting in the comparison to polka dots.

When a hemangioma is aggressive, the extraosseous extension and bone expansion can mimic the harsh impact of metastasis. This condition is the spread of cancer from an initial site to a different site within the body. The similarities between the echo reflectivity of certain hemangiomas on imaging systems and that are seen with some metastases can lead to misdiagnosis. Conducting more invasive testing on areas around the spinal column is also more challenging and risky, potentially leading to misdiagnosing these tumors as benign when they are a malignant tumor instead or vice versa.

Many healthcare providers will not recommend treating a benign hemangioma unless it has grown significantly and is impacting an individual’s quality of life. Vertebral hemangiomas that are causing neurological symptoms or substantial pain are typically the tumors treated, either through embolization, radiation therapy, removing the compromised bone or kyphoplasty. In severe cases, spinal stability may be encouraged through a bone graft and supportive hardware.