(I received a question from someone who has a hemangioma on her 9th thoracic vertebrae with compression of her spinal cord. She asked anonymously for information, so I’ve written this overview.)
A hemangioma is a vascular mass that is most commonly found in the thoracic spine. It can be progressive, weaken the vertebrae and even cause it to collapse as it infiltrates the bony structure. This weakening of the vertebral body and growing mass can put pressure on the spinal cord in rare cases, resulting in partial paralysis if not treated.
It is estimated that spinal hemangiomas occur in about ten percent of the world’s population, but less than one percent cause symptoms. In those cases, though, it is very important to receive proper treatment to maintain stability and function of the spine and legs. Fortunately, hemangiomas are not cancerous.
Treatment depends on where the tumor is located, how large it is, whether it is symptomatic and how much infiltration there is into the vertebra. The tumor can grow into the body or round solid part of the vertebra and make holes in it. The vertebra may then collapse which can damage the spinal cord and spinal nerves along with causing severe pain and dysfunction.
In this case, the hemangioma is at the 9th thoracic vertebra, and has expanded into the spinal column, pressing on the spinal cord. The plan is to remove the mass, remove the vertebra, a procedure called a corpectomy, and insert hardware and likely fuse the level above and below to ensure stability of that area of the spine.
Sometimes treatment involves embolization of the hemangioma. This treatment involves injecting a substance to stop blood flow into the mass, with the idea that reducing blood flow will reduce the size of a vascular tumor. This is not always an option. The treatment plan may involve radiation therapy in addition to surgery. This is done to prevent a recurrence, but again, whether it is appropriate depends on the specific situation.
The surgery itself also varies with the particulars of the case. The incision may be in the flank, or side of the body, but sometimes the surgeon must work from the front and the back to have the best view of the area and to place the instrumentation properly. Often what is called a cage will be inserted in the place of the removed vertebra. There may be bone grafts as well. If there are bone grafts, the surgeon will also likely use a substance that encourages bone to grow. This is helpful in a successful fusion of the spine. You want the vertebrae above and below the affected area to all grow together vertically, or fuse. This way the spine will be stable. If the vertebrae can slide from front to back, the spinal cord is not protected.
The surgery often requires several days in the hospital, possibly up to a week. If there have been pain and neurological symptoms prior to surgery, when you wake up these symptoms may be gone or lessened a great deal, depending on how long there has been pressure on the nerves and spinal cord. Usually the pain you wake up with is surgical pain rather than the previous pain from the mass. You will be encouraged to get up and moving as soon as possible, with a lot of walking on flat surfaces.
Spine surgeons differ in post-op instructions, but generally you will not be allowed to lift or bend for weeks, instructed to avoid stairs initially, and some surgeons may not want you to sit for extended periods. You may or may not have to wear a brace. You will be encouraged to walk on flat surfaces, and will have follow-up appointments with serial X-rays to be sure the instruments remain in the proper position and the vertebrae are fusing as they should. You will likely go to physical therapy after a recovery period of a couple of months.
While symptomatic thoracic hemangiomas are not common, spinal fusions are done every day. There are minimally invasive techniques that can sometimes be used, and the recovery is much faster and easier than you may be expecting if you know people who had this surgery even five or ten years ago. This is an area of surgery that is improving all the time, and if you go to an experienced surgeon, you will likely have a successful recovery and normal function afterward.
OrthoSuperSite: Spinal Cord Compression Due to Vertebral Hemangioma
Spine Universe: Spinal Tumors: Descriptive Overview
University of Southern California Center for Spine Surgery: Anterior Lumbar Corpectomy and Fusion